NCD986187128_20020328_North Belmont PCE_FRBCERCLA RA_Draft Technical Memorandum and Cost Performance Report - Water Main Extension Remedial Action-OCR

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REMEDIAL PLANNING ACTIVITIES AT SELECTED
UNCONTROLLED HAZARDOUS SUBSTANCES DISPOSAL SITES
Prepared for:
U.S. ENVIRONMENT AL PROTECTION AGENCY
REGION 4
This document has been prepared for the U.S. Environrncnta!ProtectionAgency lll'lder Contract No. 68-WS-0022. The materialcontained
herein is not to be disclosed to, discussed with, or made available to any person or persons for any reason without the prior expressed
~pproval of a responsible official of the U.S. Environmental Protection Agency.
DRAFT
TECHNICAL MEMORANDUM AND
COST AND PERFORMANCE REPORT FOR THE
WATER MAIN EXTENSION REMEDIAL ACTION AT THE
: NORTH BELMONT PCE SITE, , ..
. I ---NORTH BELMONT, GASTON COUNTY, NORTH CAR0JiJlj,l~A;-rc:,--__
. f,11_{r~-11<i_,;:; o i1 r·-
Approved By:
Approved By:
. MARCH 2002 :'11 /f. M ----~, J~"
'• L AY ·'·
l ' 72002 ,, I 'l
U.S. EPA CONTRACT NO. 68-WS-0022
WORK ASSIGNMENT NO. 108-RARA-04QD
DOCUMENT CONTROL NO. 3282-108-RT-RIRT-13835
~ c:::::::::::---~ z =5
James Laforest, P.E. ·
Project Manager
I
Mike Profit
Technical Reviewer
Prepared by:
CDM FEDERAL PROGRAMS CORPORATION
800 Oak Ridge Turnpike, Suite B-200
Oak Ridge, Tennessee 37830
Date:
Date:
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Contents;
Section 1 Introduction .......................................................... 1-1
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Section 2 Project Description .................................................... 2-1
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
Site Location and Description ....................................... 2-1
Site History ....................................................... 2-1
Record of Decision Summary .... : ................................... 2-1
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Site Conceptual Model ............................................. 2-3
2.4.1 Site Geology ............................................... 2-3
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2.4.2 Site Hydrogeology .......................................... 2-4
Remedial Investigation Summary .................................... 2-4
1'.reatability Study Summary ........................................ 2-5
2.6.1 Bioas.sessment Field Study ................................... 2-5
2'..6.2 Laboratory Microcosm Treatability Study ........ : ............. 2-5
Explanation of Significant Differences ................................ 2-5
"'.later Main Remedial Action Summary .............................. 2-6
2,8.1 Trans-State ................................................ 2-6
2.8.2 EA Engineering ............................................ 2-6
Section 3 Performance ........................................................... 3-1
3.1 Water Main Extension Performance Standards ......................... 3-1 '.
CDM
3.1.1 Obtain Approval of the Water Main Design ................... 3-1
3.1.2 Obtain All Applicable Permits ............................... 3-1
3.1.3 Obtain Utility Clearances ................................... 3-2
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3.1.4 Correct Discrepancies ....................................... 3-2
' 3.1.5 Ensure Continuous Operation of Existing Water, Sewer,
All Other Utilities, and Communications at the Site ............. 3-2
3.1.6 Post-Construction Testing .............................. , .... 3-2
3.2 RCFU Performance Standards ................................... · .... 3-3
3.2.1 Treatment Systems Shall Meet Applicable Groundwater
Quality Standards .......................................... 3-3
3.2.2 Corrective Maintenance .................................... 3-3
3.2.3 System Repair ............................................. 3-4
3.3 Residential Well Abandonment Performance Standards ................ 3-4
3.3.1 Locate the Residential Wells to Be Abandoned ................. 3-4
3.3.2 Conduct Well Abandonments in Accordance with
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Applicable Standards ........................................ 3-4
3.3.3 Obtain Required Permits .................................... 3-4
3.4 Water Main Subcontract Performance Evaluation ...................... 3-4
3.4.1 Quality Control Criteria and Results .......................... 3-5
3.4,2 Contractor Quality Control .................................. 3-6
3.4.3 Subcontractor Quality Control ............................... 3-6
02-01313282-108/0326
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3.5
Contents
Draft Technical Memorandum and Cost and Performance Report
3.4.4 Final Inspection ............................................ 3-6
Residential Well Abandonment Performance Evaluation ................ 3-7
3.5.1 Quality Control Criteria and Results .......................... 3-7
3.5.2 Contractor Quality Control .................................. 3-7
3.5.3 Subcontractor Quality Control .................... : .......... 3-8
.Section 4 Operations and Maintenance .......................................... 4-1
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Section 5 Cost and Performance Report .......................................... 5-1
5.1 Reporting Standard Terminology .................................... 5-1
5.2 Parameters Affecting Cost and Performance and Measurement
Procedures of the RCFU ............................................ 5-1
5.3 Breakdown of Project Costs ......................................... 5-2
5 _:3 .1 Project Costs ................................. : ............. 5-2
5.3.2 Subcontract Change Orders and Modifications ................. 5-4
5.4 RCFU Performance ................................................ 5-5
Section 6 References ............................................................ 6-1
Appendixes
1
COM
Appendix~
Appendix B
Appendix C
Appendix D
Appendix E
Appendix F
Appendix G
Appendix H
. Appendix I
Appendix J
Appendix K
Appendix L
AppendixM
Appendix N
Appendix 0
Appendix P,
Appendix Q
Appendix R
Appendix S
Appendix T:
02-013/3282-108/0328
' I '
Water Main Extension Connection Stahts
Residential Well Abandonment
CihJ of Belmont Approval of Water Main Design
Public Water System Authorization to Construct
Erosion and Sedimentation Control Plan Approval
Right-of-Way Encroachment Agreement
Punch List of Deficiencies
Pressure Testing Certification
Disinfection Procedure Results
Compaction Test Results
RCFU First Round Sampling Data
COM RCFU Resampling Data
Well Abandonment Forms
Hot Mix Asphalt Job Mix Formula
Certificate of Conformance -Copper Water Tube
Approved Shop Drawings
Final Inspection Checklist
Completion Notification Letter to CihJ of Belmont
Completion Notification Letter to U.S. Department of Transportation
Recommendation for Ownership and Operation of Water Main
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I Figures
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I Tables
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5-3
5-4
5-5
5-6
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02-013/3282-108/0328
Source Area Locations and Site Location Map ......................... 2-2
ROD Performance Goals ............................................ 2-3
Reporting Standard Terminology ..................................... 5-1
RCFU Characteristics Affecting Treatment Cost or Performance
and Associated Measurement Procedures ............................. 5-2
RCFU Operating Parameters Affecting Treatment Cost or Performance ... 5-2
Water Main Extension Project Costs .................................. 5-3
RCFU Project Costs ................................................ 5-3
Residential Well Abandonment Project Costs .......................... 5-4
RCFU Performance ................................................ 5-5
RCFU -Untreated and Treated Contaminant Concentrations ............ 5-6
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I Acronyms and Abbreviations
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1,2-DCE
CDM
EPA
ESD
µg/L
O&M
PCE
RA
RCFU
RI
ROD
TCE
Trans-State
voe
WBS
02-01 l/32e2-108/03211
cis-1,2-dichloroethene
CDM Federal Programs Corporation
U.S. Environmental Protection Agency
Explanation of Significant _Differences
microgram per liter
operations and maintenance
tetrachloroethene
remedial action
· residential carbon filtration unit
remedial investigation
Record of Decision
trichloroethene
Trans-State Construction
volatile organic compound
work breakdo~n structure
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CDM·
Section 1
Introduction
The objective of'this technical memorandum is to provide to the U.S. Environmental
Protection Agency (EPA) a summary of the subcontract performance and required
operations and maintenance (O&M) procedures for the water main extension and the
residential well abandonment activities at the North Belmont Tetrachloroethene
(PCE) Site, located in North Belmont, Gaston County, North Carolina.
This technical memorandum covers only the remedial action (RA) activities
associated with the water main extension, residential carbon filtration unit (RCFU),
and the residential well abandonments. This technical memorandum includes a cost
and performance report, which is presented in Section 5. The cost and performance
report was prepared in accordance with the guidance document Guide to Documenting
Cost and Performance for Remediation Projects (EPA 1995)'.
The RA activities were performed in accordance with the Final Work Plan for Remedial
Action at the North Belmont PCE Site, North Belmont, Gaston Countn;, North Carolina
(EPA 2000a), and the objectives of the North Belmont PCE Site, North Belmont, Gaston
Counh;, North Carolina: Record of Decision (ROD) (EPA 1997a). CDM Federal
Programs Corporation (COM) executed two procurements to complete the required
water main extension remedial activities. COM subcontractors performed the
following major activities, as part of the water main extension RA:
■ Extension of existing water main and connection of individual residents to city
water-COM procured Trans-State Construction (Trans-State) as the
subcontractor to perform this work. Trans-State designed and constructed the
necessary water main extensions required to service all residential lots. In
addition, Trans-State installed, tested, and maintained the RCFU.
■ Abandonment of residential drinking water wells-CDM procured EA
Engineering as the subcontractor to perform this work. EA Engineering
abandoned the residential drinking water wells after the residents were connected
to city water.
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CDM
Section2
Project Description
2.1 Site Location and Description
The identified primary source areas for the site are two closed dry cleaning
operations located in North Belmont, Gaston County, North Carolina. The locations
of these two operations are referred to as "Source Area A" and "Source Area B."
Figure 2-1 shows the source area locations and the location of the site. Source Area A,
which was operated by the Untz family from 1960 to 1975 as a dry cleaning business,
is located at Roper's Shopping Center in Land Lot 5, Parcel 15-lSA on Woodlawn
Avenue. The former dry cleaning facility is approximately 0.75 acre in size and is
bounded to the east and west by residential neighborhoods, to the north by a
cemetery and an undeveloped wooded tract, and to the south by North Belmont
Elementary School. Source Area B is located at the northeastern corner of Acme Road
and Suggs Road in Land Lot 11, Parcel 15-18. This parcel has been converted to
residential property. The majority of the area surrounding Source Area Bis
residential with a few small businesses. A cabinet shop is located to the north. A
previous refrigerator repair shop and a machine shop were also suspected to be
p0'.cntial sources of contamination. The refrigerator repair shop, now closed, is
located at the intersection of Julia Street and Acme Road in Land Lot 15-lSA, Parcel
32. This is a small commercial strip area with residential property surrounding the
site, except for a cabinet shop and a well drilling company located to the east. The
machine shop is located at the corner of Acme and Centerview Roads and is
surrounded by residential neighborhoods.
2.2 Site History
In February 1991, the Gaston County Health Department sampled the well that
provided water to the North Belmont Elementary School and two single-family
dwellings. This sampling was associated with an effort by the county to evaluate
community water supplies for volatile organic compound (VOC) contamination. The
results of this sampling indicated significant VOC contamination in the well. EPA
Region 4 Emergency Response was notified. EPA and the Gaston County Health
Department sampled 25 drinking water wells. PCE, trichloroethene (TCE), and
cis-1,2-dichloroethene (1,2-DCE) were detected in 16 samples. The elementary school
was immediately connected to the City of Belmont water system. Twenty-nine of the
neighborhood drinking water wells were taken out of service and connected to the
Belmont city water system. Seven residences in the neighborhood were informed of
the contamination but chose to continue to use their wells and not connect to city
water.
2.3 Record of Decision Summary
The North Belmont PCE Site, North Belmont Gaston Counh;, North Carolina: Record of
Decision (EPA 1997a) recommended that the groundwater remedy consist of the
following:
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SOURCEAREA ---=:::::::::::::::::19~.-;,t.\~-~-~z ~ N,ORTH B,~L~
North Belmont PCE Site
North Belmont, North Carolina
CDM
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Source Area Locations and
Site Location Map
Figure No.
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COM
. 1. Connection of all homes, churches,
and businesses in the "North
Belmont PCE Area" to the public
water supply.
2. Optional installation of carbon
filters on private wells, including
one year of filter O&M.
3. Groundwater treatment via
in-well vapor stripping.
4. In situ bioremediation.
5. Continued analytical monitoring
for contaminants in groundwater.
Table 2-1
ROD Performance Goals
North Belmont PCE Site
Section 2
· Project Description
North Belmont, NorthCarolina
Contaminant Remediation Level
Methylene chloride 5 µg/L
1,2-DCE 70 µg/L
TCE 2.8 µg/L
PCE 1 µg/L
Bis(2-ethylhexyl)phthalate 3 µg/L
Chloroform 1 µg/L
1, 1-Dichloroethene 1 µg/L
Lead 15 µg/L
The ROD performance goals for groundwater cleanup are presented.in Table 2-1.
2.4 Site Conceptual Model
A detailed description of the site conceptual model can be found in the North Belmont
PCE Site Remedial Investigation Report (EPA 1997b), the North Belmont PCE Site
Feasibiliti; Study Report (EPA 1997c), and Final Treatability Study Evaluation Report for In
Situ Bioremediation at the North Belmont PCE Site, North Belmont, Gaston Count!;, North
Carolina (EPA 2000b). -
A detailed description of the site conceptual model and known data on the nature
and extent of contamination can be found in Section 2 of Appendix A of the Final
(100%) Design for Groundwater Remediation Using In-Well Vapor Stripping at the North
Belmont PCE Site, North Belmont, Gaston Count!;, North Carolina, Revision 4 (EPA 2001).
2.4.1 Site Geology
The site is located within the central portion of the Charlotte Belt of North Carolina.
The rock types that underlie this terrain are dominated by granitic type rocks,
metavolcanics, and gneisses and schists of varying types. The rock types are of
varying metamorphic grade, and all rock units trend parallel with the strike of the
Appalachian Mountains, whJCh is typically northeast to southwest. These same units
typically dip to the southeast along with the regional topographic trend. Structurally,
the area is complex with rock units displaying one or two typ~s of metamorphism or
structural changes such as faulting or folding. A large, unnamed fault is located
approximately six miles to the west of the site.
The site is underlain by foliated to massive metamorphosed quartz diorite and
massive to weakly foliated, hornblende rich granitic type rock. These rock units have
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02·013/3282-1 0M1328
COM
Section 2
Project Description
undergone periods of deformation that have produced folding and fracture planes in
the rock, as well as brittle zones where the rock is actually crushed, sheared, or
faulted in some manner. As these rock types become weathered, soil profiles develop
that are characteristic of the original rock (also referred to as saprolite).
2.4.2 Site Hydrogeology
Regionally, the water bearing units that underlie the site and surrounding areas
represent an aquifer system consisting of metamorphosed and fractured quartz
diorite and granitic type rocks in varying proportions and thicknesses. Geologic
structures that produce high-yielding wells include contact zones of multilayered
rock units, zones of fracture concentration, and stress-relief fracture zones. Previous
studies have indicated that wells in Gaston County that are set within granite have an
average depth of 165 feet and an average yield of 18 gallons per minute. Within this
area, well depths range from 85 to over 1,000 feet and well yields range from 2½ to
116 gallons per minute. The aquifer system underlying the site generally consists of
the saprolite/ partially weathered rock aquifer and the underlying bedrock aquifer;
however, interconnection between these units is likely, thereby influencing
contaminant transport. Aquifer designations used during the remedial investigation
(RI) for the site are the saprolite aquifer, the top of bedrock aquifer, and the bedrock
aquifer.
2.5 Remedial Investigation Summary
An RI was conducted by EPA to determine the nature and extent of contamination at
the site (EPA 1997b). The following briefly summarizes conclusions from the RI
report.
1. Two source areas have been identified and named Source Area A and Source
Area B.
2. The contaminant plume is spreading. Private wells in the vicinity of the site that
were not contaminated in 1991 when EPA first investigated the site are now
contaminated.
3. Contamination detected in the shallow aquifer appears to be localized in Source
Area A (Roper's Shopping Center).
4. Contaminants have migrated from the shallow aquifer into the top of the bedrock
zone and into the bedrock aquifer. Maximum PCE concentrations detected in the
saprolite aquifer, the top of bedrock aquifer, and the bedrock aquifer during the
1996 RI sampling were 2,200 µg/L, 2,500 µg/L, and 3,500 µg/L, respectively.
5. The source of contamination in the southern edge of the plume may be either
Source Area A or Source Area B.
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02-01 3.'3282-10810328
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COM
Section 2
Project Description
6. No evidence of residual soil voe contamination has been found at either source
area. It is believed that the contaminants migrated through the soil directly into
the shallow aquifer.
7. There is no evidence of voe impacts to surface water an_d sediment in the area.
2.6 Treatability Study Summary
A treatability study was conducted to evaluate the effectiveness of in situ.
bioremediation at the site. In situ bioremediation was selected as part of the
groundwater remedy in the ROD. The treatability study was conducted in
accordance with the Final TreatabilihJ Sh1dy Work Plan, North Belmont, North Carolina
(EPA 1998a). The treatability study comprised of two major components as
summarized below. Detailed results of the treatability study may be found in the
Final TreatabilihJ Sh1dy Evaluation Report for In Situ Bioremediation at t/ie North Belmont
PCE Site, North Belmont, Gaston CounhJ, North Carolina (EPA 2000b).
2.6.1 Bioassessment Field Study
A bioassessment field study was conducted in January 1999 consisting of
groundwater sampling and analysis conducted at nine locations in the top of bedrock
aquifer and ten locations in the bedrock aquifer. Analytical results from this
sampling confirmed the presence of contaminants of concern identified in the North
Belmont PCE Site, North Belmont, Gaston CounhJ, North Carolina: Remedial Investigation
Report (EPA 1997b) and in the Data Acquisitions Report for the North Belmont PCE Site,
North Belmont, North Carolina (EPA 1998b). The main chlorinated solvents detected
were PeE, TeE, and 1,2-DeE. Also found were their biotransformation products
vinyl chloride, ethene, and ethane.
2.6.2 Laboratory Microcosm Treatability Study
A laboratory microcosm study was initiated in February 1999 to further investigate
the potential for enhancing in situ bioremediation processes for remediation of
"groundwater contamination at the site. The microcosm study was conducted under
controlled conditions to identify site-specific factors affecting the rate and extent of
reductive dechlorination of contaminants at the site. The 421-day microcosm study
found little enhancement of PeE reductive dechlorination. The presence of daughter
products was found to be insignificant. The conclusion of the study was that
complete dechlorination of PeE would not occur at the site and, therefore, full-scale
implementation of in situ bioremediation was not recommended.
2.7 Explanation of Significant Differences
As discussed in Section 2.6, a treatability·study was conducted and full-scale
implementation of in situ bioremediation was not recommended for the site. In
response to this, EPA prepared the Explanation of Significant Differences (ESD) to the
Remedial Action, North Belmont PCE·site, Belmont, Gaston CounhJ, North Carolina (EPA
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CDI\II
Section 2
Project Description
2000c). The ESD deletes the ROD requirement for the use of in situ bioremediation as
groundwater remedy for the site.
2.8 Water Main Remedial Action Summary
As stated in the Section 1, the water main RA consisted primarily of connecting
residents to city water, installing one RCFU, and the abandonment of residential
drinking water wells no longer in use. This was accomplished through the use of two
subcontractors as detailed below.
2.8.1 Trans-State
CDM procured.Trans-State as the subcontractor to:
■ design and construct the extension of existing water mains to provide city water
service to selected residences;
■ connect individual residents desiring city water to the water main extension; and
■ design, install, operate, and maintain individual RCFUs to selected residences.
The necessary water main extensions required to service all residential lots was
designed and constructed. Residents who did not select connection to the water main
extension received a connection stub and meter, which may be accessed at a later
date. At the end of construction, 74 residents were connected to city water, 25
residents were provided with a connection stub and meter only, and one resident
received an RCFU. Appendix A contains a table with a breakdown of residents and
their connection status. Those residents/lots indicated as "No Action" in the table
fell into three categories as listed below:
■ The lot had an abandoned home or structure and/ or the owner could not be
located.
■ The lot had no building or structure which required connection to city water.
■ The residence was already connected from an earlier emergency action.
Detailed information about these remedial activities can be found in the Final (100%)
Design for Extension of Existing Water Main, Connection of Individual Residences to Cihj
Water, and Installation of Individual Residential Carbon Filtration Units at the North
Belmont PCE Site, North Belmont, Gaston Counh;, North Carolina, Revision 4 (EPA
2000d).
2.8.2 EA Engineering
CDM procured EA Engineering to abandon drinking water wells for those residents
who were connected to city water. ··Appendix B contains a table of wells abandoned
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CDIM
Section 2
Project Description
as of the date of this report. In some cases residents had multiple drinking water
wells on their lot and each was abandoned. In other cases, residents had no drinking
water wells on their lot and shared a well with other resident(s).
The requirement for well abandonment activities were included in the Finni (100%)
Oesignjor Groundwnter Remediation Using In-Well Vapor Stripping at tlie North Belmont
PCE Site, North Belmont, Gaston CounhJ, North Carolinn, Revision 4 (EPA 2001).
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CDM
Section 3
Performance
This section summarizes the performance standards used to evaluate subcontractor
work in conducting the required water main extension remedial activities. As stated
in the Section 1, the water main remedial action consisted primarily of connecting
residents to city water, installing one RCFU, and the abandonment of residential
drinking water wells no longer in use. These actions were accomplished through the
use of two subcontractors (Trans-State and EA Engineering). Detailed performance
standards for the water main extension and RCFU activities (work completed by
Trans-State) may be found in the Final (100%) Design for Extension of Existing Water
Main, Connection of Individual Residences to City Water, and Installation of Individual
Residential Carbon Filtration Units at the North Belmont PCE Site, North Belmont, Gaston
Coiinh;, North Carolina, Revision 4 (EPA 2000d). Detailed performance standards for
the abandonment of residential drinking water wells (work completed by EA
Engineering) may be found in.the Final (100%) Design for Groundwater Remediation
Using ln-Weli Vapor Stripping at the North Belmont PCE Site, North Belmont, Gaston
Counh;, North Carolina, Revision 4 (EPA 2001).
Performance standards are the criteria that must be met to complete the project. The
performance standards are listed below with the results and/ or basis for the
determination that the standards were met. Sections 3.1, 3.2, and 3.3 describe the
performance standards for the water main extension, the RCFU, and the well
abandonment activities, respectively.
3.1 Water Main Extension Performance Standards
3.1.1 Obtain Approval of the Water Main Design
Trans-State was required to obtain approval of the water main design (including any
required plans, specifications, and drawings) from the City of Belmont and any other
applicable agencies prior to construction.
The City of Belmont approval (Appendix C) via a letter from David Hamilton was
obtained on October 8, 2001. All other approvals were documented as part of the
final inspection detailed in Section 3.4.4.
3.1.2 Obtain All Applicable Permits
Trans-State was required to obtain all applicable permits associated with the
construction of the water main. The State of North Carolina Department of
Environment and Natural Resources Division of Environmental Health issued a
Public Water System Authorization to Construct on July 11, 2001 (Appendix D). The
North Carolina Department of Environment and Natural Resources Division of Land
Resources approved the erosion and sedimentation control plan (Appendix E) on
September 7, 2001. The State of North Carolina Department of Transportation
granted a Right-of-Way Eni:roachment Agreement (Appendix F) on September 17,
2001. .
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02-0 1 313282-1 0Ml328
CDM
Section 3
Perfonnance
3.1.3 Obtain Utility Clearances
Trans-State was required to obtain all necessary clearances from public utility
organizations. All clearances were obtained as required. These clearances were
marked prior to excavation and construction. Completion of this activity is
documented as part of the final inspection detailed in Section 3.4.4.
3.1.4 Correct Discrepancies
Trans-State was required to correct all discrepancies noted during construction
inspections and oversight. COM conducted oversight of approximately 80% of all ·
construction activities. Minor discrepancies were noted and corrected in the field.
COM conducted a pre-final inspection and created a punch list of deficiencies with
the required completion date for each item. These punch list items were rechecked
during COM' s final inspection detailed in Section 3.4.4. The majority of deficiencies
were corrected as noted in the final punch list provided in Appendix G.
3.1.5 Ensure Continuous Operation of Existing Water, Sewer, All
Other Utilities, and Communications at the Site
Trans-State was required to maintain continuous operation of existing water, sewer,
and all other utilities, and communications at the site. This performance standard was
verified qy the oversight personnel and documented in the final inspection checklist
detailed in Section 3.4.4.
3.1.6 Post-Construction Testing
Trans-State was required to perform post-construction testing as detailed below.
These tests were required by the City of Belmont prior to their assuming O&M
responsibility of the water main. Testing was conducted in accordance with the North
Belmont PCE Site Tee/mica/ Specifications Record Documents Water System Improvements,
Gaston Countn;, North Carolina (Trans-State 2002).
3.1.6.1 Hydrostatic Testing
After the pipe was laid and partially backfilled and before any service taps were
made, the newly laid pipe and appurtenances were tested for hydrostatic pressure
and leakage. Hydrostatic testing was performed according to the approved technical
specifications. Appendix H contains the certification for pressure testing of the water
lines. The streets, dates, and witnesses present during the testing are listed.
3.1.6.2 Disinfection Testing
Before any new pipe was placed into service, the pipes were filled, disinfected, and
tested according to the technical specifications. Appendix I contains the disinfection
procedure results.
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3.1.6.3 Compaction Testing
Section 3
Perfonnance
The pipe trendies were backfilled and tested (compaction) according to the technical
specifications. Compaction testing data are located in Appendix J.
3.2 RCFU Performance Standards
Trans-State was responsible for the design, installation, testing, and operation of the
RCFU. The specific performance standards are detailed below.
3.2.1 Treatment Systems Shall Meet Applicable Groundwater
Quality Standards ·
The system, which was designed and installed by Trans-State, is required to meet all
applicable groundwater quality standards. Sampling was conducted according to the
Sampling and Analysis Plan and Waste Management Plan, North Belmont PCE Site Water
System Improvements, Belmont, Gaston Countt;, North Carolina (Trans-State 2001a), that
was prepared for Trans-State.by Roy F. Weston, Inc. In accordance with the plan,
sampling was conducted by Trans-State after installation of the RCFUs. At this time
two units had been installed and samples were taken before (influent samples) and
after (effluent samples) each of the RCFUs. Soon after installation and sampling of
the RCFUs, one of the residents (Mr. Griffith of 2209 Acme Road) requested to be
connected to city water after his groundwater well had gone dry; therefore, only one
RCFU was sampled by COM. Another round of sampling will be conducted by
Trans-State after 6 months of operation.
Data from the first round of sampling (Appendix K) of the RCFU indicated that
concentrations of acetone, methyl ethyl ketone, and tetrahydrofuran on the discharge
side of the RCFU exceeded those on the influent side of the RCFU. Evaluation of the
data suggested that these results could be attributed to glue and construction
materials used during the installation of the RCFU. To investigate this problem,
COM resampled the installed RCFU in late January 2002, and the data showed that all
discharge VOC concentrations were lower than the influent concentrations. The
COM RCFU sampling data is provided as Appendix L.
The data from the COM sampling (Appendix L) showed that all chemical
concentrations were nondetect with the exception of chloroform, which was below
the EPA National Primary Drinking Water Regulations (40 CFR Part 141) enforced
by North Carolina. Additionally, the concentration of chloroform was less than the
remediation goal [1 microgram per liter (µg/L)] for groundwater at the North
Belmont site, which is stated in the ROD (EPA 1997a).
3.2.2 Corrective Maintenance
Trans-State is required, for the period of one year, to respond to all corrective
maintenance requests within 24 hours notification from individual residents. To date,
no corrective maintenance calls have been required for the RCFU. COM will continue
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02·01313282-10e/0328
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Section 3
Perfonnance
to provide oversight to ensure that any maintenance calls within the one year
operational period are addressed within 24 hours of notification from the resident.
3.2.3 System Repair
The RCFU installed by Trans-State shall not require repair more than three times over
the one year operational period. To date, no repairs have been required on the RCFU.
CDM will continue to provide oversight to ensure that the number of repairs to the
installed RCFU does not exceed three repairs during the one year operational period.
3.3 Residential Well Abandonment Performance
Standards
EA Engineering was responsible for the abandonment of residential drinking water
wells. The specific performance standards are detailed below.
3.3.1 Locate the Residential Wells to Be Abandoned
The residential wells to be abandoned were located based on the city water
connections made by Trans-State. Some residents shared a drinking water well;
therefore, the well was not abandoned unless all parties involved were connected to
city water. Appendix B lists all the drinking water wells abandoned as of the date of
· this report.
3.3.2 Conduct Well Abandonments in Accordance with
Applicable Standards
EA Engineering was required to meet all applicable Local, State, and Federal
guidelines 'including, but not limited to, the standards listed in 15A NCAC,
Subchapter 2C, Section .0100. CDM and a representative from Gaston County
performed oversight of the residential well abandonment activities to ensure that all
applicable guidelines were met.
3.3.3 Obtain Required Permits
EA Engineering was required to obtain all permits required for the well
abandonments. As required by the State of North Carolina, EA Engineering
completed well abandonment forms for each residential drinking water well
abandoned. Appendix M contains the completed well abandonment forms.
3.4 Water Main Subcontract Performance Evaluation
Throughout the water main extension construction, CDM was on-site to provide
oversight when Trans-State was performing work. The construction oversight
activities were carried out by CDM' s project manager, the resident engineer, and field
inspector(s) (during testing). The project manager attended progress meetings and
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Section 3
Perfonnance
addressed technical, staffing, and contractual issues. The project manager also
received all subcontractor submittals, and ensured that they were reviewed in a
timely manner. _The resident engineer was on-site to review Trans-State's activities
and verify that they were following the contract documents. The resident engineer
would regularly observe the performance of the work, reviewing all major and minor
work milestones. The resident engineer was responsible for daily log book entries of
construction activities. He also provided construction photographs to the project
manager. The resident engineer provided oversight of all field tests. During certain
activities such as hydrostatic testing, City of Belmont personnel were present.
CDM performed oversight of all field work performed by Trans-State. If a field
inspector or the resident engineer observed a work deficiency, it was brought to the
attention of Trans-State's Quality Control Field Manager responsible for the field
activity. Inspections and tests were performed as required by the contract to ensure
that all work was in compliance.
The CDM resident engineer and field inspector(s) performed oversight by standing at
the work area and observing the activity, listening to Trans-State's supervisor and
questioning him, if necessary. This allowed them to determine how the activity was
being conducted, and thus whether the activity was being performed according to the
contract documents and/ or an approved methodology. If the contract documents
required a quantitative acceptance criterion or standard to be met, the oversight of the
measurement of that activity was followed up by a review of submitted test results,
or if the activity was possible to measure in the field, direct field measurements were
reviewed. If the work or a portion of the work was not performed in accordance with
the contract documents, Trans-State's supervisor or project manager was informed of
the deficiency and appropriate corrective actions were taken.
3.4.1 Quality Control Criteria and Results
Trans-State conducted various tests after installation of the water main extension.
Hydrostatic testing was performed according to the specifications in the Nortlz
Belmont PCE Site Teclznical Specifications Record Documents Water System lnzprovements,
Gaston Countn;, Nortlz Carolina (Trans-State 2002). Disinfection testing was performed
according to the procedure specified in the technical specifications (Trans-State 2002).
Backfilling was performed and compaction was tested according to the specifications
in the technical specifications (Trans-State 2002).
Prior to use at the site, construction materials were tested and/ or approved for use to
verify that certain specifications and quality measures were met. The hot mix asphalt
mix formula sheet is located in Appendix N. A Certificate of Conformance was
acquired for the copper water tube and is located in Appendix 0. Approved shop
drawings of equipment used during construction are included in Appendix P.
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02-013132e2-108f032s
CDM
3.4.2 Contractor Quality Control
Section 3
Perfonnance
CDM performed construction management and resident inspection at the North
Belmont PCE site during RA activities including the water main extension and RCFU
installation and testing. Construction management consisted of technical and
financial administration of the subcontract to monitor subcontract progress and
quality. Resident inspections consisted of on-site inspections of the work to verify
conformance with the specifications. While CDM performed these oversight
activities, responsibility for the quality of the final product rested with Trans-State.
During the work, CDM' s resident engineer prepared daily reports, which included all
construction activities performed daily. Each we_ek CDM's project manager
submitted a report to the EPA, which.included subcontractor progress reports along
with meeting minutes and schedule updates as required.
3.4.3 Subcontractor Quality Control
Responsibility for the quality control of the constructed project rested with
Trans-State. The quality control program for the project was conducted in accordance
with the Constn,ction Qualiti; Control Plan, North Belmont PCE Site Water System
Improvements, Belmont, Gaston Counti;, North Carolina (Trans-State 2001b), prepared for
Trans-State by Roy F. Weston, Inc. Trans-States's quality control field manager was
responsible for ensuring that project quality was met at all levels. · ·
3.4.4 Final Inspection
The final inspection consisted of two parts. The pre-final inspection was conducted at
the construction area (North Belmont, North Carolina) and on the project files (Oak
Ridge, Tennessee) from January 30-February 5, 2002. A pre-final inspection checklist
was created based on the performance standards associated with the work. As a
followup, CDM performed the final inspection from March 18-22, 2002. The final
inspection checklist of subcontract activities is provided as Appendix Q.
At the pre-final inspection at the site attended by CDM and Trans-State, the major
items of work remaining were established on a punch list (see Section 3.1.4). The
North Carolina Professional Engineer, F. Douglas Mooney from Roy F. Weston, Inc.,
submitted a stamped letter to the City Manager at the City of Belmont to certify that
the improvements to the water system were complete and installed in accordance
with the approved plans and specifications (Appendix R). In addition, Trans-State
submitted a letter to the U.S. Department of Transportation to notify them of
completion of the right of way encroachment (Appendix S). The final inspection was·
conducted from March 18-22, 2002, using the punch list developed during the pre-
final inspection.
The City of Belmont conducted inspections throughout and after completion of the
water main construction. On March 25, 2002, the City of Belmont Engineer
recommended acceptance of the water main extension for ownership and operation
(Appendix T).
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Section 3
Performance
3.5 Residential Well Abandonment Performance
Evaluation
Throughout the well abandonment activities, CDM was on-site to provide oversight
when EA Engineering was performing work. The construction oversight activities
were carried out by CDM' s resident engineer and a representative from Gaston
County. The project manager addressed technical, staffing, and contractual issues.
The project manager also received all subcontractor subrnittals, and ensured that they.
were reviewed in a timely manner. The resident engineer was on-site to _review EA
Engineering's activities and verify that they were following the contract documents.
The resident engineer would regularly observe the performance of the work and was
responsible for daily log book entries of construction activities.
CDM performed oversight of all field work performed by EA Engineering. If a field
inspector or the resident engineer observed a work deficiency, it was brought to the
. attention of EA Engineering's Project Manager responsible for the field activity.
Inspections were performed as required by the contract to ensure that all work was in
compliance.
The CDM resident engineer and field inspector(s) performed oversight by standing at
the work area and observing the activity. This allowed them to determine how the
activity was being conducted, and thus whether the activity was being performed
according to the contract documents and/ or an approved methodology. If the
contract documents required a quantitative acceptance criterion or standard to be
met, the oversight of the measurement of that activity was followed up by a review of
submitted data, or if the activity was possible to measure in the field, direct field
measurements were reviewed. If the work or a portion of the work was not
performed in accordance with the contract documents,_ EA Engineering's supervisor
or project manager was informed of the deficiency and appropriate corrective actions
were taken.
3.5.1 Quality Control Criteria and Results
Well abandonment activities were performed according to the specifications in 15A
NCAC, Subchapter 2C, Section .0100 and guidelines in the applicable local, state, and
federal regulations.
3.5.2 Contractor Quality Control
CDM performed construction management and resident inspection at the North
Belmont PCE site during residential well abandonment activities associated with the
RA. Project ·management consisted of technical and financial administration of the
subcontract to monitor subcontract progress and quality. Resident inspections
consisted of on-site inspections of the work to verify conformance with the
specifications. While CDM performed these oversight activities, responsibility for the
quality of the final product rested with EA Engineering. During the work, CDM' s
resident engineer prepared daily reports, which included all activities performed
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02-013132&2-1 081032&
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Section 3
Performance
daily. Each week CDM' s Project Manager submitted a report to the EPA, which
included subcontractor progress reports. along with meeting minutes and schedule
updates as required.
3.5.3 Subcontractor Quality Control
Responsibility for the quality control of the constructed project rested with EA
Engineering. The quality control program for the project was conducted in
accordance with the QualihJ Assurance/QualihJ Control Plan contained in the Pre-Design
Work Plan, In-Well Stripping, North Belmont PCE Site, North Belmont, North Carolina (EA
Engineering 2001). EA Engineering's Project Manager was responsible for ensuring
that project quality was met at all levels.
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Section 4
Operations and Maintenance
Because the O&M of the water main extension will be transferred to the City of
Belmont upon completion of construction and testing (currently scheduled for
April 2, 2002), a formal O&M Plan was not required for the water main extension
work. However, O&M documentation was required for the RCFU. Final O&M
documentation for the RCFU was not available at the time of this report. Final O&M
documentation will be provided in the Water Main Extension RA Report.
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Section 5
Cost and Per£ ormance Report
The cost and performance report was prepared in accordance with the guidance
document Guide to Documenting Cost and Performance for Remediation Projects (EPA
1995).
5.1 Reporting Standard Terminology
Table 5.1 was generated in accordance with the guidance document cited above. The
table applies only to the installation and operation of the one RCFU installed at the
site. The RCFU remedial activity is the only true "treatment" process of the water
main extension RA. The extension of the water main and connection of individual
residents to city water as well as the abandonment of residential wells were critical to
the water main RA but are no_t "treatment" processes and, therefore, were not listed
in the table. . . .
Table 5.1
Reporting Standard Terminology
Site Background
Historical Activity that Generated Contamination
SIC Code: 7216 (dry cleaning plants, except rug cleaning)
Management Practices that Contributed to Contamination
Surface disposal area
Other (discharge to septic tank)
Site Characteristics
Media Treated
Groundwater (ex situ)
Contaminants Treated
Volatile organic compounds
Treatment System
Primary Treatment Technology
Carbon adsorption
Supplemental Treatment Technology
None
5.2 Parameters Affecting Cost and Performance and
Measurement Procedures of the RCFU
Table 5-2 shows the matrix characteristics affecting treatment cost or performance
and the associated measurement procedures used in the determination of the value of
each matrix characteristic.
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02·01 313282· \08/0328
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Section 5
Cost and Perfonnance Report
Table 5-2
RCFU Characteristics Affecting Treatment Cost or Performance and Associated
Measurement Procedures
Maximum Expected
Contaminant Concentrations (µg/L) Measurement Procedure
Tetrachloroethene (PCE) 480 EPA Method 8260A
Trichloroethene (TCE) 22 EPA Method 8260A
1, 1-Dichloroethane 2.1 EPA Method 8260A
1, 1-Dichloroethene 14 EPA Method 8260A
Cis:1 ,2-Dichloroethene 26 EPA Method 8260A
Trichlorofluoromethane 810 EPA Method 8260A
Chloroform 0.87 EPA Method 8260A
Heptachlorepoxide 0.051 EPA Method 8260A
Table 5-3 shows the operating parameters affecting treatment cost or performance
and the associated measurement procedures used in the determination of the value of
each non-matrix characteristic.
Table 5-3
RCFU Operating Parameters Affecting Treatment Cost or Performance
Parameter Value Measurement Procedure
Minimum Flow Rate
Sampling and Analysis
O&M
Carbon Replacement
NA -Not applicable
10 gallons per minute Flowmeter
Two sampling events EPA Method 8260A
(initial and 6 months)
One year of O&M was provided by NA
subcontractor
Spent carbon replaced at end of NA
1 year O&M period
5.3 Breakdown of Project Costs
5.3.1 Project Costs
Project costs for the water main extension are shown in Table 5-4. The work
breakdown structure (WBS) number is shown beside its corresponding cost element. ·
The project costs presented in Table 5-4 were taken from Trans-State subcontract.
Project costs for the RCFU installation and testing are shown in Table 5-5. The WBS
number is shown beside its corresponding cost element. The project costs presented
in Table 5-5 were taken from Trans-State subcontract.
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Table 5-4
Water Main Extension Project Costs
North Belmont PCE Site, North Belmont, North Carolina
lnteragency Unit Cost
WBS# Cos!Element ($)
33 01 Design-Surveying 25,000
33 01 Design~Engineering 77,000
33 01 Licenses and Permits 8,700
33 01 Revisions 3,800
33 01 Mobilization 38,800
33 03 Construction of Water Main Extension 458,000
33 03 Water Meter/Connection Stub 620
3303 Connect Residents to Extension 1050
33 20 Asphalt Overlay 55,240
3320 Site Restoration 47,000
33 90 Drawing Revisions 3,000
3303 Post-Construction Tests/Inspection 7,500
33 91 Participation Extras . 10,250
33 92 Post~Construction Documentation 3,500
33 21 Demobilization 7,500
TOTAL
Table 5-5
RCFU Project Costs
North Belmont PCE Site, North Belmont, North Carolina
lnteragency Unit Cost
WBS# Cost Element ($)
33 01 RCFU Design 13,500
33 03 RCFU Installation/Initial Testing 24,400
33 90 O&M Documentation 750
33 03 6 Month Sampling/Sampling Report 4,485
33 03 Routine O&M Support (one year) 6,975
33 91 Post-Construction Documentation 4,500
33 92 Replace Carbon Filter 3,900
TOTAL
Section 5
Cost and Perfonnance Report
Number of
Units Cost($)
Lump sum 25,000
Lump sum 77,000
Lump sum 8,700
Lump sum 3,800
Lump sum 38,800
Lump sum 458,000
99 61,380
74 77,700
Lump sum 55,240
Lump sum 47,000
Lump sum 3,000
Lump sum 7,500
Lump sum 10,250
Lump sum 3,500
Lump sum 7,500
$884,370
Number of
Units Cost($)
Lump sum 13,500
1 24,400
Lump sum 750
Lump sum 4,485
1 Year 6,975
Lump sum 4,500
Lump sum 3,900
$58,510
Project costs for the residential well abandonment activities are shown in Table 5-6.
The WBS number is shown beside its corresponding cost element. The project costs
COM
' 02·01l/3282·108J0l2&
5.3
CDM
Section 5
Cast and Performance Report
presented in Table 5-6 were taken from the EA Engineering subcontract. The total
cost is estimated as the work is not complete at the time of this report.
Table 5-6
Residential Well Abandonment Project Costs
North Belmont PCE Site, North Belmont, North Carolina
lnteragency
WBS# Cost Element Unit Cost($) Number of Units Cost($)
33 03 Abandon Wells . 18.50/linear foot 6,347 linear feet $117,420
33 03 Electrical Work 2,640 Lump sum 2,640
TOTAL $120,060
5.3.2 Subcontract Change Orders and Modifications
During the course of subcontract activities, a number of change orders were issued to
address: (1) required construction work that was beyond the scope of the base
subcontract, (2) required oversight that was beyond the scope of the base subcontract,
and (3) work specified in the base subcontract that was not required. These scope
modifications were documented as Change Orders, which specified the addition or
deletion of specific work items.
Changes in the subcontract value resulting from the issuance of Change Orders were
documented as Modifications. Modifications documented the following: (1) changes
in the subcontract value resulting from specific Change Orders and (2) the intent to
pay /not pay for changes in the scope of work resulting from specific change orders.
Modifications were subject to the approval of the EPA Contract Officer. The
following is a summary of the.Modifications issued for work performed during the
RA activities discussed in this cost and performance report.
· 5.3.2.1 Water Main Extension and RCFU Change Orders
Change notice #1 for Trans-State included two items: (1) apply asphalt concrete
surface course as required by North Carolina Department of Transportation and
(2) reduce the number of RCFUs from four to one. The first item resulted from the
additional scope required to pave School, Acme, Centerview, and Thomas Fite
Streets. The second item resulted when three of the original four residents requesting
an RCFU chose an alternate option. The total dollar amount of this change notice
added $50,000 to the original subcontract value.
Change notice #2 for Trans-State included additional pavement required on Cody
Lane. This change notice added $5,240 to the subcontract value.
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Section 5
Cost and Performance Report
5.3.2.2 Residential Well Abandonment Change Orders
A change notice for EA Engineering resulted in the addition of $2,640 to the
subcontract value. The scope of work for well abandonment activities for the in-well
vapor stripping subcontractor included abandoning the wells and removing piping
and electrical wires. Prior to conducting the planned fieldwork, EA Engineering
determined that all dectrical wires and fuses should be permanently disconnected.
Because of health and safety concerns, the scope was changed to include a licensed
electrician to permanently disconnect the electrical power for well equipment at
either the fuse box or sub panel and unwire all connections associated with each
abandoned well.
5.4 RCFU Performance
The performance of the installed RCFU was measured as shown in Table 5-7.
Table 5-7
RCFU Performance
North Belmont PCE Site, North Belmont, North Carolina
Performance-Related Topic
Type of Samples Collected
Sampling Frequency and Protocol
Quantity of Material Tested
Untreated and Treated Contaminant
Concentrations
Cleanup Objectives
Comparison With Cleanup Objectives
Analytical Methodology
Quality Assurance/Quality Control
Other Residuals
Type of Information
• Influent and effluent water samples
• Analyzed for analytes as shown in Appendixes K and L
• Influent and effluent samples taken after installation and
after six months of operation
• First round sampling performed by Trans-State on
12/11/2001
• Resampling performed by COM on 01/30/2002
• Samples collected for VOC analysis were collected in
40-mL glass vials
• See Table 5-8 and Appendixes Kand L.
• Treat water to North Carolina Groundwater Quality
Standards listed in 15A NCAC, Subchapter 2L,
Section 0200
• All chemical concentrations in effluent samples were
nondetect with the exception of chloroform, which was
. below the EPA National Primary Drinking Water
Regulations (40 CFR Part 141)
• Chloroform's concentration was less than the
remediation goal for groundwater (Table 5-8)
• Samples, including quality control samples, are
analyzed for voes by EPA Method 8260A
• Trip blanks, field duplicates, matrix spikes/matrix spike
duplicates are collected as required in the Sampling
and Analysis Plan (Trans-State 2001a).
• Quality assurance provided as specified in the Sampling
and Analysis Plan (Trans-State 2001 a).
• Not applicable to RCFUs
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Section 5
Cost and Performance Report
The untreated and,treated contaminant concentrations for the RCFU are shown in
Table 5-8. The results are based on sampling conducted by CDM and are included in·
Appendix L.
Table 5-8
RCFU-Untreated and Treated Contaminant Concentrations
North Belmont PCE Site, North Belmont, North Carolina
Average Average Treated
Constituent/ Parameter
Methylene Chloride
1,2-DCE
TCE
PCE
Bis(2-ethylhexyl) phthalate
Chloroform
1, 1 •Dichloroethene
Lead
NA -Not applicable
ND -Nondetect '
Cleanup
Goal (µg/L)
5
70
2.8
3
15
Untreated Water Water
Concentration Concentration
(µg/L) (µg/L)
ND ND
ND ND
ND ND
ND ND
ND ND
3.2 0.99
ND ND
ND ND
Average Percent
Removal(%)
NA
NA
NA
NA
NA
69
NA
NA
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Section 6
References
EA Engineering·2001. QualihJ Assurance/Qualih; Control Plan contained in tlze Pre-
Design Work Plan, In-Well Stripping, North Belmont PCE Site, North Belmont, North
Carolina.
EPA (U.S. Environmental Protection Agency) 1995. Guide to Documenting Cost and
Performance for Remediation Projects (Publication EPA-542-B-95-002). March.
EPA 1997a. North Belmont PCE Site, North Belmont Gaston Counh;, Nortlz Carolina:
Record of Decision (ROD).
EPA 1997b. North Belmont PCE Site, North Belmont, Gaston Counh;, Nortlz Carolina:
Remedial Investigation Report. June. ·
EPA 1997c. North Belmont PCE Site Feasibilih; Study Report, Nortlz Belmont, Gaston
County, Nortlz Carolina.
EPA 1998a. Final Treatabilihj Study Work Plan, North Belmont, North Carolina.
EPA 1998b. Data Acquisitions Report for tlze North Belmont PCE Site, North Belmont,
North Carolina.
EPA 2000a. Final Work Plan for Remedial Action at the North Belmont PCE Site, Nort/1
Belmont, Gaston Countn;, North Carolina. December
EPA 2000b. Final TreatabilihJ Study Evaluation Report for In Situ Bioremediation at tlze
Nortlz Belmont PCE Site, North Belmont, Gaston Counh;, North Carolina. August.
EPA 2000c. Explanation of Significant Differences (ESD) to the Remedial Action, North
Belmont PCE site, Belmont, Gaston Counh;, North Carolina.
EPA 2000d. Final (100%) Design for Extension of Existing Water Main, Connection of
Individual Residences to CihJ Water, and Installation of Individual Residential Carbon
Filtration Units at the North Belmont PCE Site, North Belmont, Gaston Counh;, North
Carolina, Revision 4. December.
EPA 2001. Final (100%) Design for Groundwater Remediation Using In-Well Vapor
Stripping at tlze North Belmont PCE Site, Nortlz Belmont, Gaston Counh;, North
Carolina, Revision 4. January.
Trans-State (Trans-State Construction) 2001a. Sampling and Analysis Plan and Waste
Management Plan, North Belmont PCE Site Water System Improvements, Belmont,
Gaston Counh;, Nortlz Carolina. September.
6-1
02·01 3132a2-108J032S
CDM
Section 4
References
Trans-State 2001b. Constniction QualihJ Control Plan, North Belmont PCE Site Water
System Improvements, Belmont, Gaston Counh;, North Carolina. June.
Trans-State 2002. North Belmont PCE Site Technical Specifications Record Documents
Water System Improvements, Gaston Countn;, North Carolina. February.
6-2
02·01313282-1 0810328
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I Water Main Extension
Connection Status
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Table A-1
Water Main Extension Connection Status
North Belmont PCE Site, North Belmont, North Carolina
Water Stub and Carbon
Street House No. Parcel Name City Water Meter Only Filter No Action
Acme Road 2105 35 Fletcher/Hazel Conner X
2109 36 Glenda Campbell X
2111 37 Continental Cabinet X
2113 38 David Beaty X
2115 38 David Beaty X
2200 39.01 Cellco Partnership X
2201 41 Charlotte Lee X
2203 40 RoberVAngela Smith X
2205 43 Kenneth Oliver x·
2207 52 Cicero Ware X
2208 123 Kenneth/Mary Oliver X
' 2209 42 John/Mae Griffith X
2211 44C JD/Betty Leatherman X
2212 122 Darrell_ Pressley Riley X
2213 44B JD/Betty Leatherman X
2215 44A JD/Betty Leatherman X
2216 121 Ronald/Dianne Cobb X
2220 120 Mr./Ms. Holloway X
2221 45 J.P. Lyman X
2223 46 Sharon Heffner X
2224 119 Bobby/Lucille Padget X
2228 118 Jeffrey/Kathy Lynch X
2232 116 Gregory Gore X
2300 106 Centerview Baptist Church X
2304 109 Shirley McMillan X
Apricot 102 66A Fletcher/Hazel Conner X
104 66 Fletcher/Hazel Conner X
106 65 Fletcher/Hazel Conner X
Table A-1 (continued)
Water Main Extension Connection Status
North Belmont PCE Site, North Belmont, North Carolina
Water Stub and Carbon
Street House No. Parcel Name City Water Meter Only Filter No Action
Boundary 124 78.01 Lee Barnes X
2505 78.02 William/Rose Barnes X
2507 78 Joe Barnes X
2509 80,81 Jeanette Sausedo X
2513 4.08 Jerry/Deloris Penley X
2515 4.07 Joe Barnes X
2517 4.06 Phyllis Perkins X
2519 4.05 Roland/Ethel Walters X
Centerview 200 129 James/Joann Smith X
201 125 Jerome Kale X
202 128 John E. Tesnear, Jr. X
' 202A 128A John E. Tesnear, Jr. X
203 126 Eula Morgan X
204 130 Toni/Bouthong Sengmany X
205 127 ForresVShirley Morgan X X
206 115 Toni/Bouthong Sengmany X
Cody Lane 119 112.01 Hazel Spargo X
119-A 112.01A Hazel Spargo X
119-8 112.01A Hazel Spargo X
121 12A Robert Hawkins X
124 139 Ronald/Deborah Pope X
125 12B Robert Hawkins X
126 12C Robert Hawkins X
128 139.01 Harold/Mary Richard X
130 140 Randy Arrowood X
132 144 W.H. Herms X
Dumont Road 414 112.03 Larry/Treva Broome X
415 112D Dorothy Groner X
420 112.03A Larry/Treva Broome X
421 112.04 Bobby/Easter Grindstaff X
----- -- --- --- ------
---- -- -- -----!!!!!I !!!!!!I == liiiiiil iiiii -
Table A-1 (continued)
Water Main Extension Connection Status
North Belmont PCE Site, North Belmont, North Carolina
Water Stub and Carbon
Street House No. Parcel Name City Water Meter Only Filter No Action
Magnolia 108 72 Unknown X
Unknown 71A Unknown X
O'Daniel 102 114 Joann Marlowe X
105 108 Bobby/Easter Grindstaff X
106 113 Dorothy Groner X
106 1/2 113A Dorothy Groner X
106 1/2 113B Dorothy Groner X
107 109.02 Bobby/Easter Grindstaff X
110 112A Dorothy Groner X
114 112B Dorothy Groner X
114 ½ 112C Dorothy Groner X
115 110 Ernest Hambrick X
Roper 101 58 Hessie Broome X
103 57 JD/Betty Leatherman X
104 31F JD/Betty Leatherman X
106 31E JD/Betty Leatherman X
108 31C JD/Betty Leatherman X
108 ½ 310 JD/Betty Leatherman X
110 31A JD/Betty Leatherman X
110 ½ . 31B JD/Betty Leatherman X
112 30 John Smith X
114 29 Ellen Beal White X
School Street 103 49 Unknown X
104 99 Bo/Lynn Conner X
106 98.01 Unknown X
114 62 David Clanton X
116 61 Reverend Blackwell X
118 60 Reverend Blackwell X
201 14 Unknown X
Table A-1 (continued)
· Water Main Extension Connection Status
North Belmont PCE Site, North Belmont, North Carolina
Water Stub and Carbon
Street House No. Parcel Name City Water Meter Only Filter No Action
Thomas Fite 105 130.01 Richard Harris X
105A 130.01A Richard Harris X
105 ½ 131 Richard Harris X -
107 132 Paul Marvin X
109 133 David/Jacqueline Gillelan X
110 147 Mickey/Felecia Cope X
112 146 Stanley Brown Jr. X
113 134 James/Wanda Taylor X
114 145 Penelope Winchester X
115 135 James Purser Jr. X
116 143 Ned Propst X
117 137 Ray Smith X .
' 118 142 Ulan Waters X
120 141 Charles Barker X
121 138 David/Brenda Sutton X
122 139.02 Lonnie Hartness Jr. x.
123 112.02 James Patterson X
Woodlawn 380 Goshen Presbyterian Church X
505 3.05 Walls Construction X
509 3.03 Howard Walls X
515 3.02 Jeff Currant X
521 3.01" William Roper X
521B 3 William Roper X
531 2.02 Elizabeth Roper X
601 2 01 Elizabeth Roper ·X
603 79 Phyllis Roper X
605 77 James Dendy X
Total Resident Count 74 25 1 15
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I Appendix B
n Residential Well
D Abandonment
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Table B-1_
Residential Well Abandonment
North Belmont PCE Site, North Belmont, North Carolina
Well
House City Casing Well Date
Street No. Parcel Name Water Diam. (in.) Depth (ft) Abandoned Comment
Acme Road 2109 36 Glenda Campbell X 4 ·81 01/31/02
2201 41 Charlotte Lee X 3 102 01/31/02
2203 40 Robert/Angela Smith X 3 142 02/06/02
2205 43 Kenneth Oliver X 2 134 02/06/02
2207 52 Cicero Ware X 2 126 02/06/02
2209 42 John/Mae Griffith X 2 65 01/17/02
2211 44C JD/Betty Leatherman X ---
2212 122 Darrell Pressley Riley X 2 122 02/06/02
2213 44B JD/Betty Leatherman X 24 66 01/24/02
2213A 44B JD/Betty Leatherman NA 2 68 02/06/02 Extra well for 2213 Acme
Road
2215 44A JD/Betty Leatherman X ---
2216 121 Ronald/Dianne Cobb X 2 118 02/06/02
2220 120 Mr./Ms. Holloway X 2 128 02/06/02
2221 45. J.P. Lyman X 2 65 01/17/02
2221 1/2 45 J.P. Lyman NA 5 117 01/17/02 Extra well for 2221 Acme
Road
2223 46 Sharon Heffner X 2 134 01/17/02
22_24 119 . Bobby/Lucille Padget X 24 68 01/24/02
2228 118 Jeffrey/Kathy Lynch X 24,,, 65 02/06/02
2228 A 118 Jeffrey/Kathy Lynch 5 134 02/06/02 Extra well for 2228 Acme
NA Road
2232 116 Gregory Gore X 6 300 01/17/02
2234 106 Centerview Babtist Church NA 3 178 02/06102
2300 106 Centerview Baptist Church X ---Share well with 2234 Acme
Road
2304 109 Shirley McMillan X 6 148 02/05102
420 112.03A Larry IT reva Broome X ---
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Table B-1 (continued)
Residential Well Abandonment
North Belmont PCE Site, North Belmont, North Carolina
House
Street No. Parcel Nanie
Acme Road 421 112.04 Bobby/Easter Grindstaff
(continued)
Boundary 124 78.01 Lee Barnes
2505 78.02 William/Rose Barnes
2507 78 Joe Barnes
2509 80,81 Jeanette Sausedo
2517 4.06 Phyllis Perkins
2519 4.05 Roland/Ethel Walters
Centerview 200 129 James/Joann Smith
201 125 Jerome Kale
.202 128 John E. Tesnear, Jr.
202A 128A John E. Tesnear, Jr.
203 126 Eula Morgan
206 115 Toni/Bouthong Sengmany
206 115 Toni/Bouthong Sengmany
Cody Lane 119-A . 112.01A Hazel Spargo
119-B 112 Hazel Spargo
119 112 Hazel Spargo
128 139.01 Harold/Mary Richard
130 140 Randy Arrowood
132 144 W.H. Herms
Dumont Road 414 112.03 Larry IT rev a Broome
415 1120 · Dorothy Groner
420 112.03A LarryfTreva Broome
421 112.04 Bobby/Easter Grindstaff
------ -
Well
City Casing Well Date
Water Diam. (in.) Depth (ft) Abandoned Comment
X ---
x· -- -
X -- -
X 6 136 02/05/02
X -- -
X 2 96 01/25/02
X 2 92 01/25/02
X 2 82 01/25/02
X 3 132 02/06102
X 2 112 01/31/02
X 3 92 01/31/02 Same as 202 1/2
X --· -Share well with 205
Centerview
NA 2 116 01/25/02 MW-7
NA 4 133 01/25/02 MW-15
X -- -Share well with 119 Cody
Lane
X -- -
. Share well with 119 Cody
-Lane
NA 2 88 01/31/02
X 24 70 01/24/02
X ---
X ----
X 6 320 02/06/02
X - - -
X - --
X - -
-Share well with 107 O'Daniel
- --- - --- --
cc w
Table B-1 (continued)
Residential Well Abandonment _
· North Belmont PCE Site, North Belmont, North Carolina
House
Street No. Parcel Name
O'Daniel 102 114 Joann Marlowe
105 108 Bobby/Easter Grindstaff
106 113 Dorothy Groner
. 106 1/2 113A Dorothy Groner
107 109.02 Bobby/Easter Grindstaff
110 112A Dorothy Groner
114 112B Dorothy Groner
115 110 Ernest Hambrick
Roper 103 57 JD/Betty Leatherman
104 31F JD/Betty Leatherman
106 31E JD/Betty Leatherman
' 108 31C JD/Betty Leatherman
108 ½ 310 JD/Betty Leatherman
110 31A JD/Betty Leatherman
110 ½ 31B JD/Betty Leatherman
114 29 Ellen Beal White
School Street 116 61 Reverend Blackwell
118 60 Reverend Blackwell
Thomas Fite 105 130.01 Richard Harris
105A 130.01A Richard Harris
fo5½ 131 Richard Harris
107 132 Paul Marvin
107 A 132 Paul Marvin
109 133 David/Jacqueline Gillelan
110 147 Mickey/Felecia Cope
112 146 Stanley Brown Jr.
113 134 James/Wanda Taylor
114 145 Penelope Winchester
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Well
City Casing Well Date
Water Diam. (in.) Depth (ft) Abandoned Comment
X 3 174 02/06/02
X 2 75 02/06/02
X ---Share well with 114 O'Daniel
X • --. -Share well with 114 O'Daniel
' ' ~-,,x 2 84 02/06/02
·,\ \
X ---Share well with 114 O'Daniel
X 3 104 02/06/02
X 2 88 02/06/02
X 3 142 02/05/02
X 2 140 03/15/02
X ---
X ---
X ---
X ---
X ---
X 2 88 01/25/02
X ---
X 2 102 01/25/02
X 6 165 01/25/02
X ---
X ---
X 2 64 01/25/02
NA 6 130 01/25/02 Extra well on 107 Thomas Fite
X ---
X 2 78 01/25/02
·x 2 82 01/25/02
X 6 392 02/04/02
X 2 216 01/25/02
OJ ,.
Table B-1 (continued)
Residential Well Abandonment
North Belmont PCE Site, North Belmont, North Carolina
House
Street No. Parcel Name
Thomas Fite 115 135 James Purser Jr.
(continued)
116 143 Ned Propst
117 137 Ray Smith
120 141 Charles Barker
Woodlawn 521B 3 William Roper
601 2.01 Elizabeth Roper
603 79 Phyllis Roper
605 77 James Dendy
--
Well
City Casing Well Date
Water Diam. (in.) Depth (ft) Abandoned Comment
X - - -
X 24 68 01/31/02
X 6 325 01/31/02
X ---
X ---
X - - -
X - - -
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:u (1) "' g:
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0.::, g~
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Appendix C
City of Belmont Approval
of Water Main Design
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:E'i:(3:0:I:'-1:E?., PETTIS 0c STROUT, ll'iC.
co:,.;st;LTl:-:(.j E'.\'t;!>:t::r.!lS
ESL\I\LISHED 1900
{):,,;'E IVOODI..\\VN GREEN
October 8, 2001
200 1:.-1isT woonL\.\v;-.; !lo.-\n Mr. F. Dquglas Mooney
sc:m 12, Roy F. Weston, Inc.
cHARw,,.,. ,c "'" 5405 Metric Place, Suite 200
,11 .. ,,a.,11, Norcross, GA 30092-2550
704•525-7828 l'.-\X
F?S
Re: Belmont, NC
North Belmont PCE Site
Dear Mr. Mooney:
On Wednesday October 3, 2001, the City of Belmont and I met with Jim
LaForest (COM) and Troy Reeves (Trans-State). At that meeting we addressed the
issues of Mr. Hatton's (FPS) letter of June 28, 2001 and your response letter of
August 1 O, 2001. Please find the following in response to your letter (the item
numbering references the two previous correspondences):
1. Trans-State is to extend the 8" water main approximately-250' to the
intersection of Thomas Fite Street and Cody Lane. . The proposed
hydrant, shown on Thomas Fite Street near its intersection with
Dumont Avenue, will be relocated to the end of the a· water main at
Cody Lane. Valving will remain as shown. The 2• water line on Cody
Lane and beyond will remain.
3, Understanding that the permanent easement must be at least 20' wide,
· providing a copy of the easement plats to the City once they are
recorded is acceptable.
5. Follow the City of Belmont Minimum Standards.·
7.
9.
Place meters either on the front property line at the right-of-way (road
or railroad) or at the intersection of the · utility easement and the
property line.
Understanding that Trans-State intends to clear all trees in the
easement, the City reserves the · right to require a tree
protection/tunneling specification to be provided during the
construction phase of the project but prior to construction near any
subject tree.
,,
Mr. F. Douglas Mooney
October 8, 2001
Page 2
10. From reviewing the· original color drawing incorporated into the
Statement of Work, it appears that a tee and valve is indicated
(although somewhat obscured by some right-of-way lines). FPS will
· review the original drawing file on screen-to verify. In any event, the
tee, valve, and plug must be provided.
11. See No. 3, above.
16. The City and Trans-State will come to an arrangement for the line
abandonment. This arrangement will be separate from the work scope
provided by Weston.
19. COM/Weston/Trans-State to provide the City with a list of properties
where only taps and meter boxes are provided. In addition, these must
be noted on the Record Drawings provided to the City and FPS at the
end of construction.
21. See No. 5, above.
Other issues _and decisions:
A. The Fire Hydrant color must be 'Chrome Yellow" to match current City
Standards.
B. Weston to provide FPS with · the trench backfill compaction
specification including the testing standard to be used, and the means
of quality control (i.e., locations and frequency of tests, and who hires
the testing firm). Additionally, the City reserves the right to perform
independent compaction tests with the cooperation of TranState during
construction.
C. Weston and Trans-State to provide their project personnel contact
telephone numbers (day and night) to the City.
D. Trans-State to coordinate with the City for contact with NCDOT to
decide if the water main is in NCDOT right-of-way along Woodlawn or
whether it is shown on the residents property.
Any changes shall be indicated on the Record Drawings at the end of
construction. No revised drawings are needed at this time. Provided the above
items are addressed as note, we see no reason the construction could not proceed
for this project.
Ur-Mooney_PCE site -final response
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Mr. F. Douglas Mooney
October 8, 2001
Page 3
We appreciate COM, Weston, and Trans-State taking the appropriate steps
to make these water system improvements suitable for the eventual ownership and
maintenance by the City of Belmont
Please contact me if you have any questions.
DAH/jms
C: Barry Webb, City of Belmont
David Isenhour, City of Belmont
v.Jim Laforest, COM
Troy Reeves, TranState
Ltr -Mooney_PCE site -final response
David A. Hamilton, PE
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Appendix D
Public Water System
Authorization to Construct
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State of North Carolina
Department of Environment
and Natural Resources
Division of Environmental Health
Public Water Supply Section
AVA·.
n rn
~CDENR
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Linda C. Sewall, Director
Jessica G. Miles, Section Chief
Mr. Barry L. Webb, City Manager
City of Belmont
Post Office Box 431
Belmont, North Carolina 28012
Dear Mr. Webb:
July 11, 2001
Re: Water Main Extension
City of Belmont Water System
North Belmont
.Gaston County
I. D. # 01-36-015
Enclosed please find one copy of the "Application for Approval .. ." together with one copy of the referenced
plans and specifications bearing the Division of Environmental Health stamp of approval and signature of the Public
Water Supply Section Chief for the referenced project. These plans and specifications are approved under Division of
Environmental Health serial number 01-01078, dated July 9, 2001. ·
Plans and specifications prepared by Douglas Mooney, P.E., call for extending the City of Belmont distribution
system by installing 5,900 feet of 8-inch and 1,430 feet of 2-inch water mains, valves, hydrants and other
appurtenances along Cody Lane, Thomas Fire Street, Dumont Avenue, O'Daniet Street, Centerview Street, Acme
Road, S.R. 2029 (School Road) and Woodlawn Street.
Please note that an "Authorization to Construct" requires both this approval of Engineering Plans and
Specifications and submittal of a complete Water System Management Plan. No construction shalt be undertaken,
and no contract for construction, alteration, or installations shall be entered into until the Dep9rtment issues an
· Authorization to Construct Jetter in accordance with 15A NCAC 18C .0305(a).
One_copy oi e~ch enclosed document is beingJorwarded to our Mooresville Regional Office. The third copy is
being retained in our permanent files. ·
If we can be of further service, please call on us at [phone].
JWM/SMC{jhr
Enclosures: Approval Documents
cc: Britt Setzer, Regional Engineer
Gaston County Health Department
, .. , Head
Technical Services Branch
Public Water Supply Section
· -i"'. Douglas Mooney, P .E. • , " • • 0 "
1634 Mail Service Center, Raleigh, North Carolina 27699-1634 .ir. Telephone [phone] "3)• '%1@
Main Fax [phone] .ir. lab Forms Fax.[phone] ~
AM·NtttNUI
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State of North Carolina
Department of Environment -· --
and Natural Resources .
Division of Environmental Health
Public Water Supply Section
Michael F. Easley, Governor
William G. Ross, Jr., Secretary··
Linda C. Sewall, Director
Jessica G. Miles, Section Chief .
BARRY L. WEBB, CITY MANAGER
PO·Box431
Belmont.NC 28012
Dear Applicant:
July 13, 2001
Re: Authorization to Construct
NORTH BELMONT PCE SITE
BELMONT, CITY OF
GASTON County 0136015
This letter is to confirm that a complete Engineer's Report and a Water System Management Plan have been
received, and that engineering plans and specifications have been approved by the Department for NORTH
BELMONT PCE SITE, DEH Serial No. 0101078.
Jhe Authorization to Construct is valid for 24 months from the dale of this letter. Authorization to Construct
may be extended if the Rules Governing Public Water Supplies and site conditions have not changed. The
Authorization to Construct and the engineering plans and specifications approval letter, ~hall be posted at the
primary entrance of the job site before and during construction.
Approval must be secured _from the Department before any construction or installation if:
Deviation from the approved engineering plans and specifications is necessary; or
There are changes in site conditions affecting capacity, hydraulic conditions, operating units, the
function of waler treatment processes, the quality of water to be delivered, or conditions imposed by
the Department in· any approval letters. ·
Upon completion of the construction or modification and in accordance.with Rule .0303, the applicant shall
submit a certification statement signed and sealed by a registered professional engineer stating that construction
was completed in accordance with approved engineering plans and specifications, including any provisions
stipulaied in the Department's engineering plan and specification approval letter. Prior to Final Approval, the
applicant shall submit a signed certification staling that the requirements in 15A NCAC 18C .0307 (d) and (e) have
been satisfied and if applicable, a completed application for an Operating Permit and fee. Once the certification ·
statements and operating permit application and fee, if applicable, are received and datermined adequate, the
Department will grant Final Approval in accordance with Rule .0309 (a). Therefore, no construction, alteration, or
expansion of a water. system shall be placed into service until Final Approval has been issued by the Department.
If we can be of further assistance, please call [phone].
JGM:SMC
cc: BRITT SETZER, Regional Engineer
Roy F. Weston, Inc.
Sincerely, ~q,,-
Jessica G. Miles, P.E., Chief
Public Water Supply Section
---. . -!!!!!I liliiiiil iiiiW --...
.AV.A State of North Carolina
NCDENR Department of Environment and Natural Resources
Public Water System
Authorization to Construct
Public Water System Name BELMONT, CITY OF
and _PWSID No. (if available): 0136015
Project Name: NORTH BELMONT PCE SITE
Serial No: 0101078
Issue Date: 07/11/2001
'
Expiration Date: 24 months after Issue Date
In accordance with NCAC 1 BC.0305, this Authorization to c·onstruct must be posted for inspection at the primary entrance of
the job site during all construction.
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Appendix E
Erosion and Sedimentation
Control Plan Approval .
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·N(DENR-
North Carolina Department oi Environment and Natural Resources
I Michael F. Easley, Governor William G. Ross Jr., Secretary
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US EPA, Region 4
61 Forsyth A venue, Southeast
Atlanta, Georgia 30303
DIVISION OF LAND RESOURCES
LAND QUALITY SECTION
September 7, 2001
RE: LETTER OF APPROVAL WITH MODIFICATIONS
Project Name: North Belmont PCE Site, Remedial Action
Project JD: GASTO-2002-010
Location: School Street -Gaston County
Submitted By: US EPA, Region 4
Date Received: August 14, 2001
New Submittal X Revision=
River Basin: Catawba
Dear Sir or Madam:
This office has reviewed the subject erosion and sedimentation control plan. We find the
plan to be acceptable with modifications and hereby issue this Letter of Approval with
Modifications. The Certificate of Approval must be posted at the job site. The Modifications
Required for Approval are listed on the attached page. This plan approval shall expire three (3)
years following the date of approval, if no land-disturbing activity has been undertaken, as is
required by Title 15A NCAC 4B .0029.
Title 15 NCAC 4B .0018(a) requires that a copy of the approved erosion control plan be
on file at the job site. Also, this letter gives the notice required by G.S. ll3A-61.l(a) of our right
of periodic inspection to insure compliance with the approved plan.
North Carolina's Sedimentation Pollution Control Act is performance-oriented, requiring
protection of existing natural resources and adjoining properties. If, following the
commencement of this project, the erosion and sedimentation control plan is inadequate to meet
the requirements of the Sedimentation Pollution Control Act ofl973 (North Carolina General
Statute 113A-51 thru 66), this office may require revisions to the plan and implementation of the
revisions to insure compliance with the Act.
919 North Main Street, Mooresville, North Carolina 2B115
Phone: [phone] \ FAX: [phone] \ Internet: www.enr.state.nc.us/ENR
An Equal Opportunity I Affinnaiive Action Employer -50% Recycled I 10% Post Consumer Paper
Page Two
Acceptance and approval of this plan is conditioned upon your compliance with federal
and state water quality laws, regulations, and rules. In addition, local city or county ordinance or
rules may also apply to this land-disturbing activity. This approval does not supersede any other
permit or approval.
Please note that this approval is based in part on the accuracy of the information provided
in the Financial Responsibility Form which you have provided. You are requested to file an
amended form if there is any change in the information included on the form. In addition, it
would be helpful if you notify this office of the proposed starting date for this project.
cc:
1.
Your cooperation is appreciated.
Roy F. Weston, Inc.
Inspections Dept.
Sincerely,
}JJ g_/(,(_L~
fa.ahid _s. Khan
Asst. Regional Engineer
MODIFICATIONS
Additional measures may be required along the waterline if the proposed measures can
not function as intended.
ZSK/ae
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Appendix F .
Right-of-Way Encroachment
Agreement
I -6~/ 25/2001 15: 57 7048250514 CITY OF BELMONT PAGE 02
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STATE OF NORIB CAROLINA.
DEPARTMENT OF TRANSPORTATION
MCHAEL F. EASLEY
GoVERNox
COUN1Y:
SUBJECT:
· City of Belmont
POBox431
Belmont, NC 28012
Gentlemen:
Septembet 17, 2001
Gll510n
Right of Way Encroachment Agreement
SR 2021, 2027, 2029, 2032, 2033
. L YNDO TIPPETT
SECRETARY
Attached Is approved Right of Way Encroachment Agreement covering inswlation of 2 • SDR 21 PVC
and 8" DIP or SDR 18 (C-900) PVC wau:r line trenched alcng SR 2021, SR 2027, SR 2029, SR 2032, and SR
2033. An o=lay of the entire width of the pavement of 1.5" I-1 ACSC will be .reqiµre.d on longimdinal
installations within the pavcnumt, as shown on the attached map and plan sketch in Gaston County.
The encroaching party will be. responsible for installation of all necessary erosion oonttol devices.
Approval is given subject to provisions in the Agreement and attachments thereto whi.:h are made a part
of the AgrccmenL
lt would be ai,predated if you would advise our District Office in Shelby forty-eight ( 48) hours prior to the
date of beginning wotk on Installation of this encroachmem. Furthermore, it will be necessary for you to notify the
Disrrict Office in writing when work is completed on this installation.
TheDeJ?"liment ofTranoponation docs nra guarantee the right ~fway on this road, nor will it be be
responsfble for any claim fur damages brought by any property own;:i-by reason of the installation.
;lj
cc: Mr. John Williamson (Attachments)
Mr. D. D. R£ece (Attachments)
Re,;pecti\illy yours,
;7/ ;(. ~cb. pt.
M. L. Holder, P.E.
T weUlh Di~ision Engineer
P. Q. 8ox ♦7, Shelby, NC l315Hl047
Tel'l'booo: [phone] F .. : (704) 480•'40I
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09/26/2001 15:57 7046250514 CITY OF BELMOHT PAGE El3
ROUTE.· SR2027, SR2D33, ETC.·
USEPA Remed!al Act!on PROJECT North Belmont" PCE SHe·
STATE QF NORTH CAROLINA COUNTY OF.GASTON -""'-------
D!J'ARTME.NT OF TRANSPORTATION
-AND-
CITY OF BELMONT
P.O_.Box 431. Billmont, NC 28012
RIGHT OF \/AV ENCROACHHEN.T· AGREEHENT
PRIHARY AND SECONDARY HIGHWAYS
THIS AGREEMENT, made ond entered into this thoi:ztnd•Y of by and batween the Department of Jransportltlon, pa,..ty of th•
Cit of aelmont
\I I TN IS SETH:
THAT WHEREAS 1 the party of the second part desire• to encroach on th• right of way of the public ro,d deslgn•t•d •• Routo(e) SR2033, )gXtlll!'li~Y 9R2027 1 SR2029 1 SR202l, SR 203: lOcat1td ir. the eastern o tio ·.Gascon Coun wt the con5tructfon •n or erection o water system improvements, specifi~allY 8-inch and 2-inch water distribution lines.
WHEI\EAS 1 It Is ·to the mater I al advantage o.f t~c party of the second part to ~ffoc;t this .encroachment. and the party·of the first part In-the exercise of authority conferred upon it by statute, Is wt 11 Ing to perm It the encrOilchment wt thl n. the I 1ml ts of the r lght of woy dS lndlcated1 subject to the conditions of this agreement;
NOW, THEREFORE, IT JS AGREED that the party of the flr<t part hereby grants to the partv of the second part the right and privilege to make this. encroachment t1, shown ·on 11ttached plan"she8t (s), spe:c'lftcatlons and special provisions which ar~ ma~e a part Kcreof upon the followlng Condltlons1 to wit:
Th.tit th• in•t.lll11Urm, n~Htion, &liq Minhru1r.c• of th• ,aboye dHcrU..d h1<:Uit7 will ». •oooapU•h•<f J.!l «O• conilne• with ti,_ ~rt~ ot th• Hr■

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Pd,rl'• lat.at POLICII.9 A»D PRoa:DL,m, rgg ~ATlJG \Jil•JIU::5 ON HIWJ::AY ~g~,~:-~~"f io11~.::c ~1:1:;QA.:1t~:.:r~n;:>'t~r~t.1::~r= ~h. ·M~i!,:~ En:U\ .. ~ ~~ ,~.~-·ft_~in;tA9•11~-ol th• IMirt:y oI thlo til-at ~rl.
?hot th• .. 1d pert:, of th■ HCOJ\d. Plll"t bindal 1.nd otliQ"l.hl hJ.a .. 1{ to ln

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tall 41\d !Mllntl.in U1• •n.::ro,!iohlnq tacillty ln ■uch aah ,11\d p,rop.r eo11t.liticn th11t U vill r,.c.l: inh,.t.r• .. uh or end•u'IQ■r hav■l upon ■&.id h1qh1u,1, neir ob■truct 11or lnt•rtHe w11.h th• proper •oint•n~c• th■l'•of, to r■lllDU~•• th■ ;i.rtJ of th• Hr■t r.rt tor 'th• r.oet lr,curr•d !or 1111:, rapt.Sr• o,-llllllnhnonc• tO it■ ro,utvoy• 1.nd atru-oture■ nar:e•l41'Y due to th• 1n11 •ll11tiu11 ,uH:t e:r;-hhnc■ ol th• tacilith• of the l),,ll"t{ Cl th• leciond p,art. ¥id lf 1.t •n1 ti.;,1• the putY of the Uut· p.,rt •hall r•quln th■ u110.,4l of or ch<&nqu in h• lOC11tlon of th■ •ald fo.dl1tiu1 thot th.e uid p,orty of th■ ucor,.d put binda hhi■■lf, hh IUC<:lHIOr■ I.rid •11lqn:1, to praq>tly Jll!lllVYtl or olltu tn• Hid fat..l.li u ... izt. ordolr lo CQfll!Jnl to th• ■,dd r~uJ.n-nt, without uy oo■t tv· th■ J)llirty 'II th• Urtl part,
Th..t. th■ ,p,t,r1:r of 1:1\e 1■oond part a,;r••• to pr,r,irl• durlnq col'\■tn1ction •nd «ny 1tllb•M;u•nt -1.ntor,anc• pr¢p•r-■lvn,1 •1Q"n«l ligh ■, fl11qtHl\ 111.nd otli,■

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"•~nin9 d.•1c:•• for lh• p.rotaction of trdf1c: 11\ c-:,ntaraanc■ \ol'1th th■ l•teat !'i3t{" on ¥n1fo!ll Tuf ia Control ~ e

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o ti ~•t • d Hi hwa • 11nd .-...ndlnnta or Supphm•nh h•uto. !ntor-.,.. on •• o tJi• v. ru .. on rc<;I\I, • 1on1 u7 11 n, lblll. th• DI Yhion Enqin■■r of th■ party of th• tir■t I 11,■:rt.
n..t th• Pll,rt:, or th• .. COMI urt l1■nbY ac,:r•U to ir.d-.mlfy &nd ••"Y■ h■na1 .... th• p.11rt:, of th■ ftr■t put troa oll d,\ltllll;IH 11ild d'l1114' fo:r c:Luiaql tNllt U7 1riu by UHOI\ of th■ lnat«lht1oti and 11,d11ten4t1e• of thh •n-o:roe.ch.■nt.
n...t th.« _p,a:rty ol th• Hoond p..-t 1qre■1 to rHtor• .ii are•• d.lat\U"b■d d•rino in•tall,1.tio11 ■nd ',,,,llnt•ncnc• 'to th• a-11t1Dhction ol th• "tlhh~on En.,hluT' of the r,a:rty of th• fir■t ~rt. n,. party of th• •

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oow:I y>,rt •qrtH to •••rel■• n•ry r••■onllhl• prei;ai,tion d,u·1n,; oo!lUn.actlon and -1nt■n•nc« to pr-1v11J1o't 1i-od1ng of 11ciil1 alltlng or pollution~, rh.,r■, atr■aM, l■I:••• r,,..,rvoiH1, oth■r w•t•r t11pc<W1d.lt.«nt1, 9roq,nd ■1.1.rfoo■• qr ot~•r s,ro;,orty; or polluHon qf th■ al:r. n,■n ■hatl be co,nplhnoe with 11ppl1cU)h 1'11.lu •nd rll;Nl11tl<in•· of th• North ~11Jl1n• Dl'fl.aion. of £nY1ronatl\hl Mana9■11ent, lloJ"th. C.roliu Sedia•11htion Cor.trc,l Co-iH.f.cn, onQ 11ith Qrdln,1neu 4nd rll(7Ulationa Qt YU'iou.1 eo\lJ\UH, munidp,alitl .. &nd Gthu ott:l.d•l ,1q■neJ,.1■ ~•l111hnq to polh1Uon pravcr:tJ.1:.n and · cOAtrPl, Wt.u1 uy 111,tdlotion ur molntenont·• opo111t1<in diat:Jrtl• 1h• qround •t1rfac■ and the ■-d•tlnq qroul'\d c:o"Y■r, th■ p■,rt,-ot th• a«c1;1nd p11rt •gr11e• to 1e1110n anQ up1a.c1 tlla 1Qd ca i;;the1Yt1■ r•■■tabllah. th• qr••• i:o•♦t' to n•t , th• Ht!■f•eUO:\ ot th• l.lhiaion EnQ-lr111■r ot th• p,1rty of th• ·Hut put. ·
llwit th• pert-, ol th■ Ht"ond p,Art 11,qreea '\o eu\l.MI lh• ■i:t\1.Gl c(>•t ot U)" in•~c:Uon of th• work oonahin•ri ta IN r"1t"•■H.17 0'/ U,11 D:IYldon ?nq~n•■

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ot ·th• porty ot ·t~• 11ut pazt.
'that th• ~rty Qf ln

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••cond pert aqV••• to h • ..-. 11~■,llRl■ •t th• cono1:r\lctton ■it•, ~1: •l~ ta>e11 dllzin9 con• 1tru.ctlonl • ·copy cf thlll •gr•1ie.•nt 11ho .. it,11 •vid•nc• ot ,:a~p.rov«l by tho i:ioit1 ol the ttr.t P<tl"t• l'he ~rty oJ-th• , th■t. p,u rtoaan■■ th• rlgM to atop ■U "orJ: Wllua tvtclence of IPPl'O"d c~n be chown.
. Pzo:wld■d th• ••uk nont•J.,.·■d b~ thi.,.··•yrH!i<IJn"[" 1-. hl'ln11° P'9rloffl.ci OA ·i!I -~;q,f;\vd"hlrj'i;11,-;·~;;;;.t~-t;'lftlc; tlit · po.rty of tho Hcond p,rt •1Jn111 to qhe vr U•n·n11tlc• ta t),,. trhhion Erigin•er ol th• ~t"tY i,t. the Unt Pf.rt wllan "Ill work <:ic.nhln•d. honiin hut b.■n c<r:t"-phhd. t!_nhu .11r~c1t1c:1lly Oq\l•■hd );,! tha party ot th• tint put, v.-1tt•I\ nutk• ot ooapl■tlcn or·i.-orl: 01' h1Q~/WIIJ prt,J•ct1•1U1ci9l'. cona_tructtcn w111· rao b• .r■quir..:I. .
· 'ni..t ln i:h • .,., •• ol nonc<lmPlillnn•' with th• i•TM of \.hh 4,;nouot by ~h• party at th■ ncct1d p,art, th• put)I' ol U•• lir■l p,trt r•••nu th• .r~qht to •toi:i all 110rt. 1U1til th• hotlity t,•• b■■,n t,ro1.19ht into c:ocm.plianca 0-r ,._ DO'Hd troo th11 rlqht ol \l•Y At nu coat to U•• p,uty of tha tlr ■t f>11rt. . ·
Tl..:.t_it. h -,1u1"4 ;.., Woll-\ f'"1•1l'"• lh .. t U1ia ■qoHunl ,r,"l'-t.ltcc.,1• vord H ~ct1.1ol i::oriltr~t1cn•ui th"' wrui. .:ort:a■,pht•LI n.oJ"OlR lA not:~ .. :U.nUI One tJ.J )'Mr t_1oa tn• _a.111 al' 411th0:r1:Htl.On t:f'/ t~ rrt.1-at t1'e Uret p,ut ,W'I •u writ.tan wdvu 1

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.. curod by the puty of th•.!1!c:•n1d p.t,rt hoa th■ ?-'lty ol_lht. Hr~ p,«rt.
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• Duiir.-., tha r,utoraimc• uf thi■ CCZltr.td\ the atr.oiih po.rty, for 1tulf, ih udqnee11 and •ucceuor11 t.n. b1terc,t ..,.,..1naft•r r•t•.-r■,t to•• U••. •oontro.:tor• • 1qr••• •• toll~-;. . . . ..
FO~M R/W 16.1 (Rev, July I, 1977)
69/26/2001 15:57 7049250514 CITY CF BELMOHT PAGE 04
b, Nond1ecr111i11at1on1 n," contr,ictar, v1th nqorcl ta tho vort perfot1:11td by it durino thll contract 1htll aot dl•QriQlnat• on El•• qrouncu oC tac,, color, or national or1g-1n 1n the Hlection and rehntion o~ fulx;,mi• haotor•, includinQ procur,nent■ of J1at•riala and l■•••• o:I .,q-11ip111,■ot, 'l'h• i;,ontr■ctof' aholl not p,,,rtl,o1;. pat■ •!th•~ dir,ctly or J.ndir•ctly in th• di■ariAlnot1on p:-ohl.Pit♦d J;,y S,otian 31,1 of th• R•qul■tto~• ineliidJng es:iplo11Mnt· .PraQtioe■ whan th

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cont:roct coT.r■ • pr0Qn11 Ht tort)\ ir1 App.ridu B of u,. R99'111~Uon■•·
c. d I In all aolLcitathn• c-• • ~• ~ "''1 or nevc • en .-.. • , • ,;9n r•c or or -..or o a p.rlol'D■l1 under o 1ab-contrcict, indud1ng-procure11ent■ of mQtl!l'-J.al• or leu91 ot .quipll■ntl •ach ;,ot,nti■l •4lloaontracti,r •l' auppli•r 1hall b. notili•d b)' th• oontroctor gf t~ controctor'• obl 9111t!on■ w,d■r thJ.1 contr1ct ond th, R~lsUon• nl.t.tiYI tQ nondJ.■crilU.n..tion on th, qrounda ot rote•, color, o:r notional oriqiA.
d, 111for.,~:!011 111d Ae~onu lht rr,,.c,,c;or 1"111 oro~id1 ,11l11for11111!0111111d ru1oru rr~11Jrcd by \ht ~,guhtJ:111i, or ollt1dl¥H lu •• J r,,ri.,•111 t~••c~o, lttd , ... 11 p1r11t1 ,c,1u to Jn ~ook1, ruor~•, 11c,i,u11u, OU•••'"""•• of l11fol'ftotlon, ,no IU fiti11tlu n "'~Yb• dottrnin•I by tl\e ~11111,.111~ o~ Trar.1port•ll"ll or I~• '•doril 11111hl.•v Adol11lo:••tlon to bt ~tltnent 10 u,er1•ln C-plluu .. ith lwd, ~19wlu:ori1 or dlru\l"°'· \JI,.,. lfly inforNtiOII ,.4~:,1d of I C011trtna, io in th• ... 1 ... ,~. ,tOUl.j\OII of •AOlh1I -.ho f1ll1 or ,.,~u, [Q futnioh 1h11 Jnfo~llo11, th• ufltractar ohall IO Ctrt;fy 10 t~t 00,,1,..,.t of Tr1111penulo,i, •• tht Ft,.rt'I Mlg .... •y •d"oil'IIHt■dOn U •oprO~•J1!1, .nd •h•II 1•1 ,,q~ ..till ,Hortl lt·hn Ndl to 0~11!11 th• lnfo~HICl<l,
•• !~:'!!§:~ 1~~~/~;c:;;:!!::~:~1: :~ !~:; :v::;.;..~! !::ha~~~~!!~' ::11~~:P!! •~• 0;1 ~~. e~d~I ~~;~~l!:'; ~~:~;!: ::• .:! !~~! .. ~~~~•:~[ b• •pprr,prlu,., 1 .. ,1 .. ,;119, i.,.t 11ot li,.ic,, 10,
!;) wltlll'IOltlnf d pay .. •110 to V•• eo11cuuor .... ,., th• ~11toct IIMII lh• C0fllrl81Qf IDIIIIIIH, •"'4/or
(?) u11u111tron, t■r11J111t!o11 or 1u1p1111to• of 11\t COt'l:rttc, \11 wholi, or 111 paq,
f, :~~~:ar~:t !~:,::.~:~! i ~t"~t,;~~ l:~~:i•~ :::.,:~:~ l e~:f !;:~I ~h:11\:~: i :!::l "~.,.":~:u;:::-i~~i~,.:~ '='~! ~;~t :: ,:v::!.,:~&~"';!::~:' U•oreto. n,. tentracta, ~t-111 tikl 1uch ..crr011 ,;ltll ru,,cc to •••t 1ub.:.o,,t,u:t or p~,."'"'"' u th1 P1p.1rl ... nl of tnn1pc,rtnio• or ll•• , ••• ,.1 N01hw1r .,,....,1nr,u,110l'I ... ., .ir,.c:1 n f "ldfll af 111(orc!f>! , .. ,11 prc,~1s10111 l~cludln9 Ul>CTIO<IS '°' flGrlGClllplllflUI ,ro~1•~~. ho,,•~••• thH, 111 th• n1,n • """l'•~tor buorrn 1n ... 1v..i 111, or 11 1lln•t•11•• with, llrl91r1on ,.r,~ 1 1ubeo11tr1u.,, or IUpPllt• U I r.t~lt of l"l'h dt,.1111111 t"-ca,,,r1nor n17 h<1uul the Dep.rt-r>t of l1•111po,tallOl'I 10 fllUr l1110 '""I\ lld~1t011 lo prot1Ct th• lr.htelh of th• toll, 111•. h 1•dltla", 1111 -tflCtOf U'f fe<1uut th. U11itd 51Uu UI •Mt.I Into 1uc.h lltig•IJO<I ti prlt•CC 011 llllafuU c,( th• Unlud !utcl,
IN WITNESS WHER.F.OF, each of the parties to . th:1.e ~greement ha.s caused the same to be exeouted in the day and year first .above: written.
DEPARTHENT OF TI\ANSPORTATION
BY, 'la-z.1~
DIVISION ENGINEm
_City of Belmont
28012
City Manager
INSTJI.OtTtO,..S
\lh.911 th• .,,11c.nt r, • carporulo11 or 1 ...,111c:l~llty, ct.Ii 111n..,1nt 1111111 hav, u,_cM"poru, ,u1 ..., . ._ .iuu■d e., t"9 carporulo11 '"rttll"J or by c""'·...,_,ed ,lty offloll.l, 1t11lu, 1 ••'"•' or urp.oru, 1ul ani •11e1tule.11 ~Y clla ueret•ry or 1,y th• ~,ro# City cfflchl h C11 flit I~ h, ~-l•lgh .. ,,r,, er t~ H1n•111• of lllg~t ot ......... '" lht ao•n Or0Yld1d In c11l1 tpu,11e11e fer·u""\lcn, th1 ~-of th■ corPOrtt(llfl Of n.inlcJ»ltty ihtll bl lypd 1bov1 tlltl n-,n4 tltleor Ill ~r10n1 Ugnlnil t~• 19ratNn1 1holi:d be typtd •luctly IH.lo., th,fr ~l-114111r■."
llllt lgfl-1111 ...,.1 l,e Uc<>""•"ltd, 111 th■ toi-11 •' •11 ■thclvl•nt, 1,r pl•111 or dr1-ln11 1ho,..,l"1 11,_ fol\~lnJ •p~lluble Jnfgr, .. tlG111
I. All rc,1dwa,i incl, .. ,, 2. II.Ith! c,f ..ay 111111 1114 .. h••• ,,,1 tca•h, th1 tOl'ltr•I tf .cnu lln.1 J. Lot.tlc,n or \he .,.1.11,.. •r>d/or pr~o,.,, tntrolChllltnt · ~. llll!l(h, II.It 111d typt. of uc.ro.u.i'w14111t
S. l'\oth<>d of L11,1•llufoo, ,. 01..,.~alo~• •ha,,,ln11 th• dl1u11,.. ,,.,. ,.._ ""uoa~11-.n1 to Nt• of p•••-nl, oh...,ldort, 1lr10Clu•••• 11,, 1, l.otUion by hl11h.Mt 1urve1 t!•tlo,, n.,..lolf. If ltUIOII nva1r clnnu bt 11lo1,lnld, loutlo,o 1houl,I tit, 1~ ti,, 411• d!lUnte fr0/11 ,_ !d•11t\r!1t>lt point, 111ch HI btld91, rc,ad; lnteruulo,1, 11,. (ro Ulht J11 11,nur1tl11n of llw ,..,.rDtc"-H .1.,., 1•• ~•p■rl.,.llt'I ro16.fay pl•11• IIIIJ 11• u..-•~ tho v■rlo<,1 a.\gho,,.ay Otvlol""' OrfltH, o~ H tlu a..1.tgh off/u,)
I, D~••n•i• 11ru~1ure1 0~ brl'111u It df■ct■

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lly tnc.rouhmanr lo-v1rtlq,I •r,d horl1911~\ dl,..,,.lonl hOII •11Cra••II• "'1,1>t t~ IIHfUI ,1rt ■f IUUCtllrt). ,. i1l1110d of •U.-=h■tt1t ro. •ralug, 1lrll(t11rtt or br!dQtt, · 10,• lhnh<>I• dul11n • , .• II, oo, <1~hr1ro.,~4 ~il\"1i1u: the lllltoth tf bvrJ ""'"' ,II lr•••le<I lonu, ,...,..ldtra, 411tllH, tl#-lh, 11a. IJ, L111111h, 1111 ·"" IVP9 ,r IIIUH"9111 ,..,,.,. n<1U1,~,. IJ. D11 u11dfraro~11d e.10111~01, ni;i~•tlon 11 10 lfll!thool of ar<>uln11 • barln11 ••ul J•d\111, o,,an C.YI, ,,c, I~. LaclllOII of V911tl .
t£k(UL "9'JUl11!11l5
I, Any ut.i.,Nlllll 10 1 brf4QI or orl\9' drllllUto 1tr1.1ilit~r■ ..,H be 1pproi,1Ji by th• lla1d of Hn,ctijfl Oetl1,o 111 ltl

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70482513514 CITY OF BELMONT PAGE 05
NCDOT ENCROACHMENT LOCATION DATA
North Belmont PCE Site
Belmont.NC
Applicants: City of 13elrnunl -Owner
U.S. EPA funded Project
COM Federal Corp. -Manag,;r
Trans-State Co.nstruction -Contractor Roy F. We~-ton, Inc. -Designer
ROADS
S.R. 2029 (School)
24-ft wide pavemc:nt
SJ. 2.c.:z.:ic. •. " . -RE-t,,,,; l!-l> , 20-ft wide pavement
~R.a6,~
¢...,.slc~.;.,e.wct1
18-ft wido pavement
LC>(;ATION
. ,,..,_ :u1.1 From intersection of Woodlawn St. to the inter:iection of Roper St . . 111-.. ~ .. ,
From the: intersection of Suggs St. tow intersection of Centerview .SI.
From the intersection .:if Acme Rd. to the intersection of·111omas Fite Street
CONSTRUCT[ON
840 ft. of 8-inch
wilterline by open cut
735 ft. of 8-inch
water Ii ne by open cut
520 ft_ .of 8-inch
water! l'n~ by open cut
S.R. 2033 From the intersection ofRo~s Col.11:t 730 ft, of 8-inch and (Thomas Fite)
20-J\ wide pavement
to the intersection of Cody Lane 230 ft. ofZ-inch
waterline by open cut
_zy et~:..,. "R •u t.. Ra A., £.. .:....A
SR ';lo'J 11
S° 1) It. 2 1
t,'>'1 or+ ... + v.:,,,.,t.
wa...+e..-J;~~
t.,,,a lfJ (C•f-"ot)
0 ... -,;, u, • +: 1'1! :r"' • ..,
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· 09/25/2001 15:57 7048250514 CITY OF BELMONT PAGE . 06
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SPECIAL PROVISIONS
,1. Traffic shall be controlled in accordance with the Manual on Uniform Traffic Control Devices for Streets and Highways, The North Carolina Department of Transportation Construction and Maintenance Operations supplement to·_the manual on Uniform Traffic Control Devices shall be used as a guide to set up signing and flagging operations every time work is done on highway right of way.
2, Road is not to be closed without prior approval of the Division Engineer. Closure of any lane niust be approved through the District Office unless otherwise directed by the District Engineer. Only one lane of traffi~ may be closed at a time and traffic must be maintained in accordance with HUTCD as set forth in Item 1.
3. All paved cro5sings shall be by dry bore unless otherwise approved by the Division Engineer.
~. All open cuts approved by the Division Engineer are to be s~wed prior to pavement removal.
5. Material excavated from a trench shall be placed in such a manner as not to interfere with drainage, open traffic lanes, or the ingress ~regress from the roadway. If permission is granted to close a lane, written permission must be obtained from the ·District Engineer to place excavated material on paved roadway. Any excavated soil that is placed on the roadway shall have a sand blanket 0£ clean sand material bet·..:.een the soil and the roadway. The material should be removed daily and the roadway cleaned by brooming, All projects greater than 1000 feet are re.quired to use a broom tractor.
6. Certified compaction tests on subgrade density and all excavated areas under the Pavement are required, Compaction in open ~ut area~ under the pavement shall conform to North Carolina Department of Transportation Standard Specifications for Roads and Structur~s. When tested, all material to a depth of 6" below the finished surface.of the subgrade shall be compacted to a density equal to at least 100% of that obtained by compacting a sample of the material in accordance with AASHTO T99 as modified by the Department, Copies of these modified _testing procedures are available upon request from the Materials and Tests Unit.
· .09/26/2001 15:57 7048250514 CITY OF BELMONT
materials and Tests Unit.
Backfill material shall be placed ins•· loose layers free from rocks thoroughly tamped by a mechanical tamp.
PAGE 07
The subgrade shall be compacted at a moisture content which is approximately that req_uired to produce the maximum density indicated in the above test method, The Contractor shall dry or add moisture to the subgrade when req_uired to provide a uniformly Compacted and acceptable subgrade.
When the utility is placed within the traveled portion of the roadway in an open cut for longitudial placement, after proper installation, compaction, placement of ff" of ACBC,Type H or S" ACBC, Type HE, it will ·be necessary that the disturbed secti6n of roadway be overlayed its entire width (1,5'' ACSC I-1 or I-2) for the parallel distance of the disturbed pavement. -
Pavement shall be patched with a minimum of 6" of HE Cone. Base Course or 6" Cone, Binder Course H, with a 2" minimum of surface course (ACSC Type I-2 or I~l) when road is not to be resurfaced.
8. All asphalt materials shall conform to the NCDdT Standard Specifications for Roads and Structures, Section 600, Bituminous Bases and Pavements,
9. Every area that is disturbed as a result of this encroachment shall be re-shaped to the satisfaction of the Division Engineer for North Carolina Department of Transportation or his representative. This shall include the use of a motor grader to smooth and level shoulders and pull ditches for jobs greater than 1000 feet. The disturbed areas shall be reseeded every 1000 feet in agreement with the following:
The soil shall ~e scarified to a depth of not less than five inches and shall be worked into an acceptable seedbed. Limestone; fertilizer, and seed shall be applied within 24 hours after the seedbed is prepared and immediately worked so as to cover the seed with a layer of soil. The hand-bucket method is not acceptable. All seeded area$ shall be mulched with approved materials within 36 hours after seeding. Mulch shall be held in place by applying a sufficient amount of asphalt or othe~ approved material when or immediately after mulch is applied.
10. This agreement does not in any way provide permission to perform any work on railroad right of way or on private property.
11, Anp pavement cut of driveway or drive entrances on •
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. 09/26/2001 15: 57
12.
13.
15.
16.
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7048250514 CIT'/ OF BELMONT
material as was originally in place, unless writ~en permission is obtained from the District Engineer.
Existing hi1hway drainage structures shall be bored under when the encroachment is for trenching.
PAGE 08
No ~ater meters or valve boxes shall be Placed in the ditch line,
Fire hy'drants shall be of bi:-eak-away type and placed back of ditch,
All service connections crossing the ro_adway shall be installed by dry bore,
Ditches and drains shall be pi:-ovided and maintained when required to satisfactorily drain the subgrade. When previously approved subgrade is damaged by natural causes, by hauling equipment, or by other traffic, the Contrac~or shall restore the subgrade to the required lines, 1~ades, and typical sections as well as to the requi~ed densicy at no cost to the Department.
. . . Minimum three feet .of cover and three feet frqr edge of pavanent for pipeline.
09/25/2001 15:57 7048250514 CITY OF BELMONT
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AppendixG
Punch List of Deficiencies
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Water Main Extension Subcontract Final Inspection Punch List
North Belmont PCE Site
North Belmont, Gaston County, North Carolina
Completion Due
Item Description Date
General
Connect residents who established City of Belmont accounts after March 18, 2002
January 22, 2002.
Power of the Spirit Church at the intersection of School and March 18, 2002
Roper-Repair the bent lock hasp on the small access door at the
point at which the city water goes into the building.
Ensure all new fire hydrants have fresh paint in accordance with March 18, 2002
City of Belmont regulations.
Provide copies of the Plumbing Inspection Reports March 18, 2002
Provide final Operations and Maintenance Manual for the March 18, 2002
Residential Carbon Filtration Units
Changes to Record Drawings
M0dify record drawings to show more accurate locations of water February 22, 2002
meter boxe_s. Examples include but are not limited to:
(1) water meter box on Boundary, Parcel 4.07
(2) water meter box on Boundary, Parcel 4.08
Revise record drawing to show all residents at the end of O'Daniel February 22, 2002
Street.
Revise record drawing to show all connections at O'Daniel, February 22, 2002
Parcels 106 and 106½.
Revise record drawing to show correct locations of fire hydrants on February 22, 2002
Cody Lane and Thomas Fite Street.
Show repavement of Cody Lane on record drawings. February 22, 2002
Revise all record drawings to reflect residential final connection February 22, 2002
status.
Paperwork for Files
Send CDM a non-faxed copy of the following: February 22, 2002
(1) July 11, 2001 letterfrom Mr. Munden, P.E., Head Technical
Services Branch Public Water Supply Section
(2) July 13, 2001 letter from Jessica Miles, P.E., Chief Public
Water Supply Section
(3) The NCDENR Public Water System Authorization to
Construct certificate issued on July 11, 2001.
Send CDM a fully executed copy of the North Carolina Department February 22, 2002
of Transportation (NCDOl) Right of Way Encroachment
Agreement (including signatures from NCDOl).
Resubmit the pre-design coordination meeting minutes to CDM. February 22, 2002
Produce 90% Design review meeting minutes (including a list of February 22, 2002
attendees, date of meeting, and major decision points).
Produce Pre-construction meeting minutes (including a list of
attendees, date of meeting, and major decision points).
February 22, 2002
CDM needs a letter or an e-mail from the City of Belmont stating March 18, 2002
that all fees (not deposits) have been paid by Trans,State
Construction.
Send CDM a copy of the letter submitted to the City of Belmont by March 18, 2002
Mr. Hamilton indicating his approval of the post constr_uction
submittals and the water main construction.
CDM
02-01313282-1 08/0328
Final Inspection-
Completed
(Yes/No)
Yes
Yes
Yes
No
No
Yes
Yes
Yes
.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No, waiting for City
-of Belmont to
complete letter
G-1
Water Main Extension Subcontract Final Inspection Punch List (continued)
North Belmont PCE Site
Completion Due
Item Description Date
Submit an updated schedule, which reflects actual dates for February 18, 2002
project activities. Also, the dates and items established at the post
construciton meeting with the City of Belmont should be listed.
Send CDM a copy (signed by the City of Belmont) of the March 18, 2002
Completion letter to NCDENR.
Provide CDM and the City of Belmont a table listing the final February 22, 2002
residential connection status.
Paving and Road Work
Repair the indention in the centerline of the new pavement on March 18, 2002
School Street.
Repair the indention in the centerline of the new pavement on March 18, 2002
Acme Street east of the Acme/Centerview/O'Daniel intersection.
Repair the indention.in the centerline of the new pavement at the March 18, 2002
west end of Acme Street.
Repair pavement damage on Cody Lane. March 18, 2002
Silt Fence
Remove all erosion control features after vegetation has been TBD
established. For example, the silt fence at Woodlawn, Parcel 77
needs to be removed after vegetation has been established.
Site Restoration
Remove equipment from the main staging area. Grade, reseed, March 18, 2002
and landscape staging area.
Numerous areas need to be reseeded and landscaped. These March 18, 2002
areas include but are not limited to:
(1) area east of building on Woodlawn, Parcel 77
(2) east section of lot on Woodlawn, Parcel 4
(3) around meter box on Boundary, Parcel 78.01
(4) around meter box on Boundary, Parcel 78.02
(5) line to residence on Centerview, Parcel 129
(6) around meter boxes on Centerview, Parcel 128
(7) area at DumonUO'Daniel intersection on O'Daniel,
Parcel 113
(8) around 2 meter boxes on O'Daniel, Parcel 112
(9) around meter box and area southeast of building on
O'Daniel, Parcel 106
(10) around meter box on O'Daniel, Parcel 109.02
(11) around meter box on O'Daniel, Parcel 110
(12) around meter box on Dumont, Parcel 112.03
(13) area east of building on Dumont, Parcel 112.03
(14) around meter box and area east of building on Dumont,
Parcel 112.03A
(15) area in lot west of Ross CourUThomas Fite intersection
(16) line to residence on Thomas Fite, Parcel 131. ...
(17) around fire hydrant on Thomas Fite, Parcel 147
COM
02-01313282-1 0810328
Appendix G
Punch List of Deficiencies
Final Inspection-
Completed
(Yes/No)
No
No, waiting for City
of Belmont to
complete letter
Yes
Yes
Yes
Yes
Yes
No, will be
completed after
vegetation has been
established
No, some additional
grading is required
for the staging area
next to 102 O'Daniel
Street
Yes
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Water Main Extension Subcontract Final Inspection Punch List (continued)
North Belmont PCE Site
Completion Due
Item Description Date
(18) around meter box on Thomas Fite, Parcel 145
(19) around meter box on Thomas Fite, Parcel 1_43
(20) around meter box on Thomas Fite, Parcel 141
(21) around 3 meter boxes on west side of Cody Lane
Repair crack in concrete pad at Acme, Parcel 52. March 18, 2002
Remove asphalt debris on side of road at Acme, Parcel 38. March 18, 2002
Damaged Equipment
R_epair/replace outer casing on valve box in centerline of School March 18, 2002
Street in front of School Street, Parcel 13.
Repair/replace outer casing on valve box in centerline of O'Daniel March 18, 2002
Street at Dumont/O'Daniel intersection.
Post Construction Documentation
Resubmit post construction documentation in response to March 22, 2002
comments from COM and the City of Belmont.
Revise drawing 1 of 10 so that it is consistent with the detailed March 25, 2002
drawings (drawing 2 through 10) in regards to connection status of
residents.
COM
02-01313282-1 08/0323
Appendix G
Punch List of Deficiencies
Final Inspection-
Completed
(Yes/No)
Yes
Yes
Yes
No
No
No
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AppendixH
Pressure Testing
Certification
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TRANS-STATE CONSTRUCTION COMPANY
January 30,2002
Roy F. Westori, Inc.
Suite 200
5405 Metric Place
Norcross, Georgia 30092-2550
Attn: Doug Mooney, P.E.
Re: North Belmont PCE site
Dear Mr. Mooney: ·
UTILITY CONTRACTOR
Phone [phone]
Fax . [phone]
MEMBER: AGC AND NUCA
Trans-State Construction Co. is providing you with a letter of certification for pressure testing of•
water lines for the above referenced project. All lines within the project were tested for a 2 hour
duration at a pressure rating of 200 PSI. No loss of pressure was observed. Listed below are
streets, dates, and witnesses present during testing.
1: Thomas Fite Street / Cody Lahe
Tested October 31, 2001
· Observed by
Donald Sigmon, Trans-State Construction Co.
Gary Gallagher, City of Belmont
2. Centerview Street I Acme Road/ O'Daniel Street
Tested November 13, 2001
3.
4.
Observed by
Donald Sigmon, Trans-State Construction Co.
Danny Whisnant, City of Belmont
School Street/ Dumont Avenue
Tested December 11, 2001
Observed by
Donald Sigmon, Trans-State Construction Co.
Frank Lathon, City of Belmont
Woodlawn Avenue/ Boundary Street
Tested January 18, 2002
Observed by
Donald Sigmon, Trans::State Construction Co.
Gary Gallagher, City of Belmont
Frank Lathon, City of Belmont
"WE DIG THE CAROLINAS"
P.O. BOX 545 • DENVER, NC 28037 • TEL [phone] • FAX [phone]
After pressure testing was concluded, all lines were sterilized and samples were taken to Chem-
Bae Laboratories, Inc. of Charlotte, North Carolina: Attached ~e copies of bacteria reports
showing all lines are clear and meet the requirements for domestic use.
If you have any questions, please call our office.
Sincerely,
Trans-State Construction Company, Inc.
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Disinfection Procedure
Results
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P.O. BOX 19198 CHARLOTTE, N.C. 2821_9
TEL: 70 ◄-l9 ◄-6l81 • FAX: 70 ◄•l9 ◄·6l82
Client: Trans Slate Construction Co
POBox545
Denver, NC 28037
Attn: Todd Reeves
Certificate of Analysis
Client Number:
Work Order:
Sample Date:
Report Date:
, TRANS-STAT~ co:isr;:uci':c:1 co. •
1081
3096-01
11-12-01 .
11-15-01
Bacteriological Examination of Water Samples
Sample
Acme 3/4 BO Belmont
2" Line BO 2"0ff Acme BO
Centerview Fire Hydrant
O'Daniel St 2" BO
Total Coliform
(colonies/ 100 cc)
0
0
0
0
In the absence of the coliform group of n,ganisrns lhis-water meets the requirements of
The American Public Health Association for domestic use .
Respectfully Submitted,.
Chern-Bae Laboratories, Inc
. O,u~
Jor,ep{ C ~ubllell
Supervising Chemist .
INDEPEN,DENT LABORATORIES • CHEMISTS • B_ACTERIOLOGISTS • CONSULTANTS
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CHEM-BAC L~, 11te.
.• )' !.
II 1Rr~::s-s-:-AT= """'l'!''T~l; ... T,0,. co . • ·-........ ,.} :,i.,;..,. 11 •
Client: Trans State Construction· Ce.
P.O.BOX545
Denver,N,C.28037
• P. 0. BOX 19198, CHARLOm, N. C. 28219
Certificate of ~ysis
TEL [phone]
FAX#: [phone]
Oient Number:
Work Order:
Sample Date:
_Report Date:
1081
3091-01
11-13-01
11-16-01
Bacteriological F.xarnin•tion of Water Samples
I. Thomas Fite BO 3/4"
2. N. Cody Lane BO 1.-"
3. S. Cody Lane BO I"
Total Coliform
Colonies/ 100 cc
0
0
0
In the absence of the coliform: group oforganisms tltls water meets the requirements of
The-Ameiican Public Health Asoociation for domestic use.
Respectfully Submitted,
Chem-Bae Laboratories, Inc
9-~-tt·
Joseph C Hubbell s . . Chemist upcmsmg .
H D E P E N D EN T .LA 8 0 RAT O R I ES • C H IM IS T. S • I ACT ER 10 LOG IS TS • CO N S U L T·A NT S
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Client:
P.O. BOX 19198 CHARLOTTE·.-···N.C:, 28219
TEL: [phone] • FAX: [phone]
Trans State Construction Co.
P.O.BOX545
Denver, N.C. 28037
Certificate of AnalysiJ
Client Number:
Work Order:
Sample Date:
Report Date:
.. Jll,;NS.STATE CONSTnUCTION CO,
1081 ·
3241--01
12-12--01
12-12--01
Bacteriological Examination of Water Samples
Sample
North Belmont Dwnont Ave
North Belmont School St
Total Colifonn
Colonies/ 100 cc
a
0
In.the absence oftht' colifnnn group ofl'ltganisms Ibis water meets the requirements of
The American Public Health Association for domestic use.
Respectfully Submitted,
· . Chem-Bae Laboratories, Inc
<µr
Joseph C Hubbell
Supervising Chemist
1:
1 INDEPENDENT LABORATORIES• CHEMISTS• BACTERIOLOGISTS• CONSULTA!'ITS
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P.O. IIOX 19191 CHAIILOTTI!, N,C. 28219
TEL: 704•J94•6JI I • PAX: 7G ◄•U4°6JIZ
Clicru: Tram State Comttudion Co.
P.O.BOX 5.JS
Demer. N.C. 28037
Attn: Todd Reeves
Certificate of Anlllysis
Clieot Number:
Work Order:
SampleDme:
Rqx>rt Daie:
1081
1080-02
01-21-02
01-22--02
Bllderlologlcal E.llllllinalloo ·,:1 Water Sample
Sample
North Belmont Sil Woodlawn
Total Coliform
Colonies / 100 cc
0
In 1hc absence of lhe ailiform group of organisms this war.er m.cds the requiremenl• of
The AmeriC:lll Public Health Association for domestic use.
Rcspcdli1Dy SubmiUed,
Ch=-Bac Laboralories, Inc
<)l,1-r
Jti5cph C Hubbell
Supervising Cbcmis1
INDIP&NDENT LABORATORIES• CHEMISTS• BACTERIOLO.GISTS • CONSULTANTS
' TESTING • INSPICTION • DEVELOPMENT • QUALITY CONTROL
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Compaction Test
Results
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0 .BARRIER ENGINEERING, PC
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REPORT OF
JRANS-STATE CONSTRUCTION CO. IN PLACE SOIL DENSITY
PROJECT NAME NORTH BELMONT WATERLINE PROJECT NO.
PROJECT LOCATION BELMONT, NC REPORT NO.
CLIENT TRANS STATE CONSTRUCTION REPORT DATE
PROJECT SPECIFICATION 100% TEST METHOD
4214 Statesville Road
Charlotte, NC· 28269
704-599-0862, Fax [phone]
1733
1
10/31/01
ASTM D1556
MAXIMUM DRY DENSITY (1) 105.1 (2) 113.7 (lbs/ft3) OPTIMUM MOISTURE . (1) 29.7 (2) 16.6 (%)
I . SAMPLE DESCRIPTION (1 )RED SLIGHTLY PLASTIC, SLIGHTLY MICACEOUS, CLAYEY SILT WITH ROCK FRAGS
(2) RED MICACEOUS PLASTIC CLAYEY SILT WITH SAND & ROCK FRAGS.
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DATE TEST FILL FIELD DRY
OF TEST DEPTH MOISTURE DENSITY
TEST NO LOCATION (feet) % (lbs/ft3)
I 10/31 1 (1) STA. 0+70 C/L PIPE THOMAS GRADE 26.5 105.8 FITE ROAD
10/31 2 (2) ST A. 2+80 C/L PIPE THOMAS GRADE · 26.8 119.4 FITE ROAD ,
10/31 3 (2) STA. 7+60 C/L PIPE THOMAS GRADE 25.6 119.1 FITE ROAD
REMARKS: TEST RESULT MEET OR EXCEED SPECIFICATION REQIUREMENTS.
% PASS/
FAIL COMP (P/F)
100+ p
100+ p
100+ p
n
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BARRIER ENGINEERING, PC
REPORT OF
. IN PLACE SOIL DENSITY
4214 Stalesvilla Road
Charlotte, NC 28269
704-599-0862, Fax [phone]
PROJECT NAME
PROJECT LOCATION
NORTH BELMONT WATERLINE PROJECT NO. ______ 1cc7c:.33=--------
BELMONT, NC
CLIE!IIT . TRANS STATE CONSTRUCTION
PROJECT SPECIFICATIONc__ ___ -=9:::.5':.::.¼, __ _
REPORT NO.
REPORT DATE
TEST METHOD
2
11101/2001
. ASTM 01556
MAXIMUM ORY DENSITY _ __.:_:10:.:5:.:.1-~(l.:cbslft'c.:.:.;),___ OPTIMUM MOISTURE __ 1c:8;..:.B ___ i.:(%::.,) __ _
SAMPLE DESCRIPTION . RED SLIGHTLY PLASTIC, SLIGHTLY MICACEOUS, CLAYEY SILT WITH ROCK FRAGS
DATE TEST TEST I FILL FIELD DRY % PASS/ OF , DEPTH MOISTURE DENSITY FAIL TEST NO LOCATION ' (feet) % (lbsltt3) COMP. (P/F)
11/01 1 STATION 1+60 CODY ROAD 3' 18,0 106.1 1QQT p
11/01 '2 STATION 1·"20 DUMONT ROAD 3' 13.4 94.0 89.4 F
REMARKS:*= FAILING TEST. RETEST TO BE DONE AT A LATER DATE.
D .BARRIER ENGINEERING, PC
• 4214 Statesvi/le Road
Charlotte, NC 28269
704-599-0862, Fax [phone]
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REPORT OF
IN PLACE SOIL DENSITY
PROJECT NAME NORTH BELMONT WATERLINE PROJECT NO. ______ 1_7_3_3 ____ _
PROJECT LOCATION BELMONT, NC
CLIENT TRANS STATE CONSTRUCTION -----'--'-"-"-"--'-'---'-"'~-'-=-'-'-'-'-'---'---
PROJECT SPECIFICATION:...._ ___ ~9.:c.5°:.c.1/o __ _
MAXIMUM DRY DENSITY 105.1 (lbs/ft3) _ ___;__;:..::..:.c. _ __,__-'---
REPORT NO.
REPORT DATE
TEST METHOD
3
11/02/2001
ASTM 01556
OPTIMUM MOISTURE __ 1_8_.8 ___ _._(0;.:.¼L..) __ _
SAMPLE DESCRIPTION RED SLIGHTLY PLASTIC, SLIGHTLY MICACEOUS, CLAVEY SILT WITH ROCK FRAGS
DATE TEST TEST FILL FIELD DRY % PASS/
OF DEPTH MOISTURE DENSITY FAIL
TEST NO LOCATION (feet) % (lbs/ft3) COMP. (P/F)
11/02 1 STA. 0+80 CENTERVIEW ROAD 3' . 22.2 105.1 100 p
11/02 2 STA. 0+40 CENTERVIEW ROAD 3' 21.5 104.8 99.7 p
11/02 3 STA. 5+90 CENTERVIEW ROAD 3' 19.9 105.0 99.9 p
1 · REMARKS: TEST MEET OR EXCEED SPECIFICATION REQUIREMENTS
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BARRIER ENGINEERING, PC
REPORT OF
IN PLACE SOIL DENSITY
4214 Statesville Road
Charlotte, NC 28269
704-599-0862, Fax [phone]
PROJECT NAME NORTH BELMONT WATERLINE PROJECT NO. ______ 17_3_3 ____ _
PROJECT LOCATION BELMONT, NC 4
CLIENT TRANS STATE CONSTRUCTION ----'.;._;;_;;..;..=_..::..:..:..:..:...=c.::...:::c:.=..:..:....;.::...c:...c..:..::..c __ 11/05/2001
I PROJECT SPECIFICATION ____ ,---_9_5°_¼ __ _
REPORT NO.
REPORT DATE
. TEST METHOD ASTM D1556
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MAXIMUM DRY DENSITY -105.1 (lbs/ft) ----~-~--OPTIMUM MOISTURE __ 1_8_.B ___ _,_(0.;..;;¾,.,_) __ _
SAMPLE DESCRIPTION RED SLIGHTLY PLASTIC, SLIGHTLY MICACEOUS, CLAYEY SILT WITH ROCK FRAGS
DATE TEST FILL FIELD DRY % PASS/ OF TEST DEPTH MOISTURE DENSITY FAIL TEST NO LOCATION (feet) % (lbs/ft3) COMP. (P/F)
11/05 1 STATION 0+40 ACME ROAD 3' 19.6 106.6 100+ p
11/05 2 STATION 2+08 O' DANIEL ROAD 3' 17.4 107.4 102.1 p
I REMARKS: TEST MEET OR EXCEED SPECIFICATION REQUIREMENTS
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BARRIER ENGINEERING, PC
REPORT OF
IN PLACE SOIL DENSITY
4214 Statesville Road
Charlott~, NC 28269
704-599-0862, Fax [phone]
'"-:---_ ~,;-,:;~~ .
. , ._;_...,U ~ \~ !\ \,l
\. \ > --....;;..· 0
\\!.,
., ~ I... ., ... ,,1 i-.~; -. ·= t,,. ...
. TRANS-S1.~TE CC{~S1?.UC1iON CO.
PROJECT NAME NORTH BELMONT WATERLINE PROJECT NO. ____ . _ __;_17:....:3c;:.3 ____ _
PROJECT LOCATION BELMONT, NC
CLIENT TRANS STATE CONSTRUCTION
PROJECT SPECIFICATION SEE BELOW ----'------
REPORT NO.
REPORT DATE
TEST METHOD
5
11/06/2001
ASTM D1556
MAXIMUM DRY DENSITY 105.1 (lbs/ft3) ----~-~--OPTIMUM MOISTURE __ 1;..;8.;.;..8 ___ _,_(0.:.:1/o.L) __ _
SAMPLE DESCRIPTION RED SLIGHTLY PLASTIC, SLIGHTLY MICACEOUS, CLAYEY SILT WITH ROCK FRAGS
DATE TEST FILL FIELD DRY % OF TEST DEPTH MOISTURE DENSITY
TEST NO LOCATION (feel) % ' (lbs/ft3) COMP.
11/06 1 STATION 2+12 ACME ROAD 3' 20.3 106.9 100+
11/06 2 STATION 3+50 O' DANIEL ROAD 3' 19.8 108.2 100+
REMARKS: SPECIFICATION IS 100% UNDER PAVEMENT AND 95% UNDER UNPAVED AREAS.
TEST MEET OR EXCEED SPECIFICATION REQUIREMENTS.
PASS/
FAIL
(P/F)
p
p
I BARRIER ENGINEERING, PC
I 4214 Statesville Road
Charlotte, NC 28269
704-599-0862, Fax [phone]
I
I REPORT OF
IN PLACE SOIL DENSITY
I PROJECT NAME NORTH BELMONT WATERLINE PROJECT NO. ------'-17'""3.c.3 ____ _
I PROJECT .LOCATION BELMONT, NC
CLIENT TRANS STATE CONSTRUCTION ---'--'-'--'-"---'--'-'-'-'-"'-"-'~-'-'-'--'-----I PROJECT SPECIFICATION'---'--..::S.:::;E;::_E .::.B;::_EL~O'-W-'----
REPORT NO.
REPORT DATE
TEST METHOD
. OPTIMUM MOISTURE
6
11/07/2001
ASTM 01556
18.8 · (%) I MAXIMUM DRY DENSITY __ 1_0_5._1 _--'-(lb_s_11t_,_3
)_· __
SAMPLE DESCRIPTION RED SLIGHTLY PLASTIC, SLIGHTLY MICACEOUS, CLAYEY SILT WITH ROCK FRAGS
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DATE
OF
TEST
11/07
11/07
11/07
TEST TEST
NO LOCATION
1 STATION 4+80 ACME ROAD
*2 STATION 2+40 DUMONT ROAD
3 STATION 2+50 DUMONT ROAD
'
'
FILL FIELD DRY % DEPTH MOISTURE DENSITY
(feet) % (lbs/ft3) COMP.
3' 20.5 106.6 100+
3' 20.7 103.6 98,6
3' 20.3 104.4 99.4
I REMARKS:.= RETEST. TEST# 2 IS RETEST OF TEST# 2 DONE ON 11/01/01. ( )<~ Rcr,1 ),. a)
I
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SPECIFICATION IS 100% UNDER PAVEMENT AND 95% UNDER UNPAVED AREAS.
TEST MEET OR EXCEED SPECIFICATION REQUIREMENTS
PASS/
FAIL
(P/F)
p
p
p
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BARRIER ENGINEERING, PC
REPORT OF
IN PLACE SOIL DENSITY
PROJECT NAME NORTH BELMONT WATERLINE PROJECT NO. ______ 17_3_3 ____ _
PROJECT LOCATION BELMONT, NC 7
CLIENT TRANS STATE CONSTRUCTION 11/08/2001
I PROJECT SPECIFICATION._ __ _::cSE:::E::..;B:::E:=L:;:;O.;..:W:.__
REPORT NO.
REPORT DATE
TEST METHOD ASTM D1556
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MAXIMUM DRY DENSITY ---"10:..:5.:..:..1....:____;,.,· (.:..:.lb;;:;.s/.:..:.ft~-<-) _. -~ OPTIMUM MOISTURE ___ 18_.8 ___ ._.("""%-'-) __ _
SAMPLE DESCRIPTION RED SLIGHTLY PLASTIC, SLIGHTLY MICACEOUS, CLAYEY SILT WITH ROCK FRAGS
DATE TEST TEST FILL FIELD DRY % PASS/
OF DEPTH MOISTURE DENSITY FAIL
TEST NO LOCATION (feet) % (lbs/ft3) COMP. (P/F)
11/08 1 STATION 5+80 ACME ROAD 3' 18 106.1 100+ p
REMARKS: SPECIFICATION IS 100% UNDER PAVEMENT AND 95% UNDER UNPAVED AREAS.
TEST MEET OR EXCEED SPECIFICATION REQUIREMENTS
I
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{;jARRIER ENGINEERING, PC
REPORT OF
IN PLACE SOIL DENSITY
4214 Statesville Road
Charlotte, NC 28269
704-599-0862, Fax [phone]
PROJECT NAME
PROJECT LOCATION
NORTH BELMONT WATERLINE PROJECT NO. _____ .:..17'""3c::.3 ____ _
BELMONT, NC
Cl~NT ___ TR.:.:,:::A::,:N::::S..:::ST.:.:A::..:T.::E..::C:.:::O.:.:.N:..STR~U::::C-.:.:.1::::0N:.:,..__
PROJECT SPECIFlCA TION, __ __;S::..:E==E:...:B:.:E:;LO::..:Wc.:,,,__
REPORT NO.
REPORT DATE
TEST METHOD
8
12/0412001
ASTM D1556
MAXIMUM DRY DENSITY 105.1 (lbs/1\31 ____ ....:.._.;;,__ OPTIMUM MOISTURE __ ·_1_8_.8 __ __,,(o/,~0.:...\ __
SAMPLE DESCRIPTION RED SLIGHTLY PLASTIC, SLIGHTLY MICACEOUS Ci.AVEY SIL i WITH ROCK FRAGS
DATE TEST TEST ALL FIELD DRY I PASSi
OF .DEPTH MOISTURE DENSITY! % FAIL
TEST NO LOCATION (fuel) % (lbsll!') J COMP. (P/F)
12/04 1 STATION 2+20 SCHOOL STREET 3' 17.6 105.5 I 1\)0 ! p I ; ;
I I I
I ! ' I I
' :
i I
' I I
REMARKS: SPECIFICATION IS 100% UNDER PAVEMENT AND 95% UNDER UNPAVED AREAS.
TEST MEET OR EXCEED SPECIFICATION REQUIREMENTS
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~ARRIER ENGINEERING, PC
REPORT OF
IN PLACE SOIL DENSITY
4214 Statesville Road
Charlotte, NC 28269
704-599-0862, Fax [phone]
PROJECT NAME NORTH E!ELMCNT WATERLINE PROJECT NO. _____ ....:1.:..:73:..:;3 ____ _
PROJECT LOCATION BELMONT, NC
CLIENT TRA'JS STATE CONSTRUCTION __ ___;,,;..:...::.:::::...;;:..:.....;.;.;:..;:=..:="-=-"-"-'-'-.:..;_-
PROJECT SPECIFICATION SEE 88..0W
REPORT NO.
REPORT DATE
TEST METHOD
9
12/05/2001
ASTM D1556
MAXIMUM DRY DENSITY 105.1 (lbs/ft")· OPTIMUM MOISTURE ___ 1_8_.B __ __,,_(0:..:.YoL) __
SAMPLE DESCRIPTION RED SLIGHTLY PLASTIC. SLIGHTLY MICACEOUS, CLAYEY SILT WITH ROCK FRAGS
DATE TEST TEST FILL FIELD I DRY PASS/
OF DEPTH MOISTURE I DENSITY % FAIL
TEST NO LOCATION (feet) % . ! (lbsifrl COMP. (PiF)
12104 1 STATION 3+80 SCHOOL STREET 3' 17.9 105.0 1CO p
•
. i
' i I
REMARKS: SPECiFICATION IS 100% UNDER PAVEMENT AND 95% UNDER UNPAVED AREAS.
TEST MEET OR EXCEED SPECIFICATION REQUIREMENTS
------------------
REPORT OF IN-PLACE DENSITY TESTING
PROJECT MAME NORTH BEUIONTPPEWE ! PROJECT NO. 1733
IIARRIER EttGINEERING, PC
4214 Slate5vlle Road; Chartrle. Jlor.h C&clina 2112611
phone J fax: (70,1) 539 OM? / (704) :,Q9.7756
hllpJ-.IMl,NA"'IIJ-..g.oom
·-I REPORT NO. 10 DATE 2115'02
~ECT LOCATDN Ba.MONT, NC. CLIENT NAIIE 1RAHS STATE CONSTRUCTION SHEET 1 OF 1
: SPECIFIED CONIPACTIOt,I 00 95 % T£ST MEl1iCD ASTIII 1MB ..
I
, ENGINEER .1,REID BAILEY. PE. TECHNICIAN D. RICHARDSON
TEET TDT 1ES-T 50L Fill.
OAlE NO. . LOCATION DE5CJU!'TIOII DEPm
2/15 1 STATIONa.90 RED SUGJiTLY PLASTIC. SUGJffi. Y SG
BOUNDRYST. ~ICACEOUS. CLAYEY SILT wmt ROCK FRAGS
2/15 2 STATION~12 RED SUG.HTI.. Y PLASTIC. SUGHTL Y SG
'NOODI.JI.WN AVE . MICACEO!JS, ClAYEV SILT WrrH ROCK FRAGS
. STATION 11+83 RED SLIGHTLY PLASTIC, SUGHTL Y
2115 3 WOODlAWIII AVE. UJCACEOUS, ClAYEY SIi.. T WITH ROCK FRAGS SG
2/15 4 STATION 1,4-.50 RED SLIGHTLY PLASTIC. SLIGHTLY SG
WOODLAWN AVE.. UICACEOUS. CLAYEYSI..TWITH ROCK_FRAGS
2115 5 STATION 18+94 RED SLIGHTLY PL\STIC. SLIGHTLY SG
WOODLAWN AVE. UICACEOUS, CLAYEY SL T WITH ROCK FRAGS
...
-
REIAARKS: TEST MEETS OR EXceEDS SPECIFICATION REQUIREMENTS.
OPT. FIELD --MOISll.JAE
(ll,) ('1,)
18.8 21.2
18JI 1!1.3
18.8 22.7
16.8 20.5
18.8 19.8
-DRY
(PCF) DeJISIIY CCIII'.
tJ'CFI "'
105. 1 107.S 100-,-
106.1 101A 97
1C6.1 106.2 tOC>t-
105.1 103.5 99
105.1 101.5 r:17
BARRIER
th8 ad of engineering
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I AppendixK
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RCFU First Round
I Sampling Data
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--VOLATILES SAMPLE ANALYSIS ---------EPA -REGION IV SESD, ATHENS, GA --

-
. Production Date7211fflo1 ffls -
Sample 722 FY 2002 Project: 02-0116
VOLATILES SCAN
Fadlity: North Belmont PCE Site North Belmont, NC
Program: SF
Id/Station: IN / MORGAN-IN
Media: GROUNDWATER
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
25.U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
25.U UG/L
1.0U UG/L
1.0U UG/L
8.4 UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
DICHLORODIFLUOROMETHANE
CHLOROMETHANE
BROMOMETHANE
VINYL CHLORIDE
CHLOROETHANE
TRICHLOROFLUOROMETHANE (FREON 11)
1,1-DICHLOROETHENE (1, 1-DICHLOROETHYLENE)
1, 1,2-TRICHLORO-1,2,2-TRIFLUOROETHANE (FREON 113)
METHYLENE CHLORIDE
METHYL T-BUTYL ETHER (MTBE)
ACETONE
CARBON DISULFIDE
METHYL ACETATE
1, 1-DICHLOROETHANE
CIS-1,2-DICHLOROETHENE
2,2-DICHLOROPROPANE
METHYL ETHYL KETONE
BROMOCHLOROMETHANE
TRANS-1,2-DICHLOROETHENE
CHLOROFORM
1,2-DICHLOROETHANE
1, 1, 1-TRICHLOROETHANE
CYCLOHEXANE ..
1, 1-DICHLOROPROPENE
CARBON TETRACHLORIDE
BROMODICHLOROMETHANE
METHYL ISOBUTYL KETONE
1,2-DICHLOROPROPANE
METHYLCYCLOHEXANE
DIBROMOMETHANE .
TRANS-1,3-DICHLOROPROPENE
TRICHLOROETHENE (TRICHLOROETHYLENE)
BENZENE
DIBROMOCHLOROMETHANE
1, 1,2-TRICHLOROETHANE
Produced by: Allen, Frank_
Requester: ·
Project Leader: GBENNETT
Beginning: 10/30/2001 11 :55
Ending:
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L ·
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
CIS-1,3-DICHLOROPROPENE
BROMOFORM
BROMOBENZENE
1, 1,2,2-TETRACHLOROETHANE
TETRACHLOROETHENE (TETRACHLOROETHYLENE)
· 1 ,3-DICHLOROPROPANE
METHYL BUTYL KETONE
TOLUENE
CHLOROBENZENE
1, 1, 1,2-TETRACHLOROETHANE
ETHYL BENZENE
(M-AND/OR P-)XYLENE
O-XYLENE
STYRENE
1,2,3-TRICHLOROPROPANE
O-CHLOROTOLUENE
P-CHLOROTOLUENE
1,3-DICHLOROBENZENE
1,4-DICHLOROBENZENE
1,2-DICHLOROBENZENE
1,2-DIBROMOETHANE (EDB)
ISOPROPYLBENZENE
N-PROPYLBENZENE
1,3,5-TRIMETHYLBENZENE
TERT-BUTYLBENZENE
1,2,4-TRIMETHYLBENZENE
SEC-BUTYLBENZENE
P-ISOPROPYL TOLUENE
N-BUTYLBENZENE
1,2-DIBROMO-3-CHLOROPROPANE (DBCP)
1,2,4-TRICHLOROBENZENE
HEXACHLORO°1 ,3-BUTADIENE
1,2,3-TRICHLOROBENZENE
A-average•value. NA-not analyzed. NAl-interferences. J-estimated value. N-presumptive evidence of presence of material.
K-actual value is known to be less than value given. L-actual value is known to be greater than value given. U-material was analyzed for but not detected. the number is the minimum quantitation limit.
R-qc indicates that data unusable. compound may or may not be present. resampling and reanalysis is necessary for veri_fication. Page 1 of 1
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VOLATILES SAMPLE ANALYSIS -----

-

-

-

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EPA -REGION IV SESD, ATHl':NS; GA . -Sample 723 FY 2002 Project: 02-0116
VOLATILES SCAN
Facility: North Belmont PCE Site North Belmont, NC
Program: SF
Id/Station: OUT/ MORGAN-OUT
Media: GROUNDWATER
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
25.U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
83. UG/L
1.0U UG/L
1.0U UG/L
1.6 UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
DICHLORODIFLUOROMETHANE
CHLOROMETHANE
BROMOMETHANE
VINYL CHLORIDE
CHLOROETHANE
TRICHLOROFLUOROMETHANE (FREON 11)
1, 1-DICHLOROETHENE (1, 1-DICHLOROETHYLENE)
1, 1,2-TRICHLORO-1,2,2-TRIFLUOROETHANE (FREON 113)
METHYLENE CHLORIDE
METHYL TcBUTYL ETHER (MTBE)
ACETONE .
CARBON DISULFIDE
METHYL ACETATE
1, 1-DICHLOROETHANE
CIS-1,2-DICHLOROETHENE
2,2-DICHLOROPROPANE
METHYL ETHYL KETONE
BROMOCHLOROMETHANE
TRANS-1,2-DICHLOROETHENE
CHLOROFORM
1,2-DICHLOROETHANE
1,1,1-TRICHLOROETHANE
CYCLOHEXANE ·
1, 1-DICHLOROPROPENE
CARBON TETRACHLORIDE
BROMODICHLOROMETHANE
METHYL ISOBUTYL KETONE
1,2-DICHLOROPROPANE
METHYLCYCLOHEXANE
DIBROMOMETHANE
TRANS-1,3-DICHLOROPROPENE
TRICHLOROETHENE (TRICHLOROETHYLENE)
BENZENE
DIBROMOCHLOROMETHANE
1, 1,2-TRICHLOROETHANE
Produced by: Allen, Frank
Requester:
Project Leader: GBENNETT
Beginning: 10/30/2001 12:10
Ending:
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
1.0U · UG/L
1.0U UG/L
ANALYTE
CIS-1,3-DICHLOROPROPENE
BROMOFORM
BROMOBENZENE
1, 1,2,2-TETRACHLOROETHANE
TETRACHLOROETHENE (TETRACHLOROETHYLENE)
1,3-DICHLOROPROPANE
METHYL BUTYL KETONE
TOLUENE
. CHLOROBENZENE
1, 1, 1,2-TETRACHLOROETHANE
ETHYL BENZENE
(M-AND/OR P-)XYLENE
O-XYLENE
STYRENE
1,2,3-TRICHLOROPROPANE
O-CHLOROTOLUENE
P-CHLOROTOLUENE
1,3-DICHLOROBENZENE
1,4-DICHLOROBENZENE
1,2-DICHLOROBENZENE
1,2-DIBROMOETHANE (EDS)
ISOPROPYLBENZENE
N-PROPYLBENZENE
1,3,5-TRIMETHYLBENZENE
TERT-BUTYLBENZENE
1,2,4-TRIMETHYLBENZENE
SEC-BUTYLBENZENE .
P-ISOPROPYL TOLUENE
N-BUTYLBENZENE
1,2-DIBROMO-3-CHLOROPROPANE (DBCP)
1,2,4-TRICHLOROBENZENE
HEXACHLORO-1,3-BUTADIENE
1,2,3-TRICHLOROBENZENE
A-average value. NA-not analyzed. NAl-interferences. J-estimated value. N-presumptive evidence of presence of material.
K-actual value is known to be less than value given. L-actual value is known to be greater than value given. LI-material was analyzed for but not detected. the number is the minimum quantitation limit.
R-qc indicates that data unusable. compound may or may not be present. resampllng and reanalysis is necessary for verification.
Page 1 of 1
VOLATILES SAMPLE ANALYSIS
Sample 723 FY 2002 Project: 02-0116
MISCELLANEOUS COMPOUNDS
Facility: North Belmont PCE Site
Program: SF
Id/Station: OUT I MORGAN-OUT
Media: GROUNDWATER
North Belmont, NC
RESULTS UNITS
20JN UG/L
ANALYTE
TETRAHYDROFURAN
EPA-REGION IV SESD, ATHENS, GA Production Date: 12/11/2001 11 :36
Produced by: Allen, Frank
Requester:
Project Leader: GBENNETT
Beginning: 10/30/2001 12:10
Ending:
A-average,value. NA-not analyzed. NAl-interferences. J-estimated value. N-presumptive evidence of ~resence of m~terial. · _ _ _ _ · _ _ _ ·
K-actual value•is known to be less than value given. L-actual value is known to be greater than value given. U-matenal was analyzed for but not detected. the number 1s the mrmmum quant1tat1on l1m1t.
R-qc indicates that data unusable. compound may or may not be present. resampling and reanalysis is necessary for verification. -
Page 1 of 1 ----- - - - -- - -- -----
--

-
·--VOLATILES SAMPLE ANALYSIS -Sample 724 FY 2002 Project: 02--0116
VOLATILES SCAN
Facility: North Belmont PCE Site North Belmont, NC
Program: SF
Id/Station: IN/ GRIFFITH-IN
Media: GROUNDWATER
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
6.4 UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
25.U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U U~/L
25.U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U · UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
DICHLORODIFLUOROMETHANE
CHLOROMETHANE
BROMOMETHANE
VINYL CHLORIDE
CHLOROETHANE
TRICHLOROFLUOROMETHANE (FREON 11)
1, 1-DICHLOROETHENE (1,1-DICHLOROETHYLENE)
1, 1,2-TRICHLORO-1,2,2-TRIFLUOROETHANE (FREON 113)
METHYLENE CHLORIDE .
METHYL T-BUTYL ETHER (MTBE)
ACETONE
CARBON DISULFIDE
METHYL ACETATE
1, 1-DICHLOROETHANE
CIS-1,2-DICHLOROETHENE
2,2-DICHLOROPROPANE
METHYL ETHYL KETONE
BROMOCHLOROMETHANE
TRANS-1,2-DICHLOROETHENE
CHLOROFORM
1,2-DICHLOROETHANE
1, 1, 1-TRICHLOROETHANE
CYCLOHEXANE
1, 1-DICHLOROPROPENE
CARBON TETRACHLORIDE
BROMODICHLOROMETHANE
METHYL ISOBUTYL KETONE
1,2-DICHLOROPROPANE
METHYLCYCLOHEXANE
DIBROMOMETHANE
TRANS-1,3-DICHLOROPROPENE
TRICHLOROETHENE (TRICHLOROETHYLENE)
BENZENE
DIBROMOCHLOROMETHANE
1, 1,2-TRICHLOROETHANE
-Produced by: Allen, Frank
Requester:
Project Leader: GBENNETT
Beginning: 10/30/2001 12:45
Ending:
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
i:ou UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L ·
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
1.0U UG/L·
1.0U UG/L
ANALYTE
cIs,1 ,3-DICHLOROPROPENE
BROMOFORM
BROMOBENZENE
1, 1,2,2-TETRACHLOROETHANE
TETRACHLOROETHENE (TETRACHLOROETHYLENE)
1,3-DICHLOROPROPANE .
METHYL BUTYL KETONE
TOLUENE
CHLOROBENZENE
1, 1, 1,2-TETRACHLOROETHANE
ETHYL BENZENE
(M-AND/OR P-)XYLENE
O-XYLENE
STYRENE
1,2,3-TRICHLOROPROPANE
O-CHLOROTOLUENE
P-CHLOROTOLUENE
1,3-DICHLOROBENZENE
1,4-DICHLOROBENZENE
1,2-DICHLOROBENZENE
1,2-DIBROMOETHANE (EDB)
ISOPROPYLBENZENE
N-PROPYLBENZENE
1,3,5-TRIMETHYLBENZENE
TERT-BUTYLBENZENE
1,2,4-TRIMETHYLBENZENE
SEC-BUTYLBENZENE
P-ISOPROPYL TOLUENE
N-BUTYLBENZENE
1,2-DIBROMO-3-CHLOROPROPANE (DBCP)
1,2,4-TRICHLOROBENZENE
HEXACHLORO-1,3-BUTADIENE
1,2,3-TRICHLOROBENZENE
A-average 11alue. NA-not analyzed. NAl-interferences. J-estimated value. N-presumptive evidence of presence of material.
K-actual value is known to be less than value given. L-actual value is known to be greater than value given. LI-material was analyzed for but not detected. the number is the minimum quantitation limit.
R-qc indicates that data unusable. compound may or may not be present. resampling and reanalysis is necessary for verification. Page 1 of 1
------VOLATILES SAMPLE ANALYSIS
Sample 725 FY 2002 Project: 02-0116
VOLATILES SCAN
Facility: North Belmont PCE Site North Belmont, NC
Program: SF
Id/Station: OUT/ GRIFFITH-OUT
Media: GROUNDWATER
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
76. UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L .
71. UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
DICHLORODIFLUOROMETHANE
CHLOROMETHANE
BROMOMETHANE
VINYL CHLORIDE
CHLOROETHANE
TRICHLOROFLUOROMETHANE (FREON 11)
1, 1-DICHLOROETHENE (1, 1-DICHLOROETHYLENE)
1, 1,2-TRICHLOR0-1,2,2-TRIFLUOROETHANE (FREON 113)
METHYLENE CHLORIDE
METHYL T-BUTYL ETHER (MTBE)
ACETONE
CARBON DISULFIDE
METHYL ACETATE
1, 1-DICHLOROETHANE
CIS-1,2-DICHLOROETHENE
2,2-DICHLOROPROPANE
METHYL ETHYL KETONE
BROMOCHLOROMETHANE
TRANS-1,2-DICHLOROETHENE
CHLOROFORM
1,2-DICHLOROETHANE
1, 1, 1-TRICHLOROETHANE
CYCLOHEXANE
1, 1-DICHLOROPROPENE
CARBON TETRACHLORIDE
BROMODICHLOROMETHANE
METHYL ISOBUTYL KETONE
1,2-DICHLOROPROPANE
METHYLCYCLOHEXANE
DIBROMOMETHANE
TRANS-1,3-DICHLOROPROPENE
TRICHLOROETHENE (TRICHLOROETHYLENE)
BENZENE
DIBROMOCHLOROMETHANE
1, 1,2-TRICHLOROETHANE
---. Production DaP-i2,.01 ~6 -
Produced by: Allen, Frank
Requestor:
Project Leader: GBENNETT
Beginning: 10/30/2001 13:00
Ending:
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
CIS-1,3-DICHLOROPROPENE
BROMOFORM
BROMOBENZENE
1, 1,2,2-TETRACHLOROETHANE
TETRACHLOROETHENE (TETRACHLOROETHYLENE)
1,3-DICHLOROPROPANE
METHYL BUTYL KETONE
TOLUENE
CHLOROBENZENE
1, 1, 1,2-TETRACHLOROETHANE
ETHYL BENZENE
(M-AND/OR P-)XYLENE
O-XYLENE
STYRENE
1,2,3-TRICHLOROPROPANE
0-CHLOROTOLUENE
P-CHLOROTOLUENE
1,3-DICHLOROBENZENE
1,4-DICHLOROBENZENE
1,2-DICHLOROBENZENE
1,2-DIBROMOETHANE (EDS)
ISOPROPYLBENZENE
N-PROPYLBENZENE
1,3,5-TRIMETHYLBENZENE
TERT-BUTYLBENZENE
1,2,4-TRIMETHYLBENZENE
SEC-BUTYLBENZENE
P-ISOPROPYL TOLUENE
N-BUTYLBENZENE
1,2-DIBROMO-3-CHLOROPROPANE (DBCP)
1,2,4-TRICHLOROBENZENE
HEXACHLOR0-1,3-BUTADIENE
1,2,3-TRICHLOROBENZENE
A-average ~,alue. NA-not analyzed. NAl-interferences. J-estimated value. N-presumptive evidence of presence of material.
K-actual value•is known to be less than value given. L-actual value is known lo be greater than value given. LI-material was analyzed for but not detected. the number is the minimum quantitation limit.
R-qc indicates that data unusable. compound may or may not be present. resampling and reanalysis is necessary for verification. Page 1 of 1
VOLATILES SAMPLE ANALYSIS EPA-REGION IV SESD, ATHENS, GA
Sample 725 FY 2002 Project: 02-0116
MISCELLANEOUS COMPOUNDS
Facility: North Belmont PCE Site North Belmont, NC
Program: SF
Id/Station: OUT/ GRIFFITH-OUT
Media: GROUNDWATER
RESULTS UNITS
40JN UG/L
ANALYTE
TETRAHYDROFURAN
Production Date: 12/11/2001 11 :36
Produced by: Allen, Fra_nk
Requestor:
Project Leader: GBENNETT
Beginning: 10/30/2001 13:00
Ending:
A-average_value. NA-not analyzed. NAl-interferences. J-estimated value. N-presumptive evidence of presence of material. ·
K-actual value-is known to be less than value given. L-actual value is known to be greater than value given. LI-material was analyzed for but not detected. the number is the minimum quantitation limit.
R-qc indicate~ that data unusable. compound may or may not be present. resampling and reanalysis is necessary for verification~
Page 1 of 1 - ----- - - -- --- - ----
--

-
--VOLATILES SAMPLE ANALYSIS -------EPA -REGION IVSESD, ATHENS, G~ --

-

-
-----Production Dafe:12/11/Z001'TT:36
Sample 726 FY 2002 Project: 02-0116
VOLATILES SCAN
Facility: North Belmont PCE Site
Program: SF
North Belmont, NC
Id/Station: DUPLICAT / DUPLICATE
Media: GROUNDWATER
RESULTS UNITS
1.0U UG/L
0.52J UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
6.7 UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
25.U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
25.U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L ·
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
DICHLORODIFLUOROMETHANE
CHLOROMETHANE
BROMOMETHANE
VINYL CHLORIDE
CHLOROETHANE
TRICHLOROFLUOROMETHANE (FREON 11)
1, 1-DICHLOROETHENE (1, 1-DICHLOROETHYLENE)
1, 1,2-TRICHLORO-1,2,2-TRIFLUOROETHANE (FREON 113)
METHYLENE CHLORIDE
METHYL T-BUTYL ETHER (MTBE)
ACETONE
CARBON DISULFIDE
METHYL ACETATE
1, 1-DICHLOROETHANE
CIS-1,2-DICHLOROETHENE
2,2-DICHLOROPROPANE
METHYL ETHYL KETONE
BROMOCHLOROMETHANE
TRANS-1,2-DICHLOROETHENE
CHLOROFORM
1,2-DICHLOROETHANE
1, 1, 1-TRICHLOROETHANE
CYCLOHEXANE
1, 1-DICHLOROPROPENE
CARBON TETRACHLORIDE
BROMODICHLOROMETHANE
METHYL ISOBUTYL KETONE
1,2-DICHLOROPROPANE
METHYLCYCLOHEXANE
DIBROMOMETHANE
TRANS-1, 3-DICHLOROPROPENE
TRICHLOROETHENE (TRICHLOROETHYLENE)
BENZENE .
DIBROMOCHLOROMETHANE
1, 1,2-TRICHLOROETHANE
Produced by: Allen, Frank
Requestor:
Project Leader: GBENNETT
Beginning: 10/30/2001 12:45
Ending:
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
.1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
CIS-1,3-DICHLOROPROPENE
BROMOFORM
BROMOBENZENE
1, 1,2,2-TETRACHLOROETHANE
TETRACHLOROETHENE (TETRACHLOROETHYLENE)
1,3-DICHLOROPROPANE
METHYL BUTYL KETONE
TOLUENE
CHLOROBENZENE
1, 1, 1,2-TETRACHLOROETHANE
ETHYL BENZENE
(M-AND/OR P-)XYLENE
O-XYLENE
STYRENE
1,2,3-TRICHLOROPROPANE
O-CHLOROTOLUENE
P-CHLOROTOLUENE
1,3-DICHLOROBENZENE
1,4-DICHLOROBENZENE
1,2-DICHLOROBENZENE
1,2-DIBROMOETHANE (EDS)
ISOPROPYLBENZENE
N-PROPYLBENZENE
1,3,5-TRIMETHYLBENZENE
TERT-BUTYLBENZENE
1,2,4-TRIMETHYLBENZENE
SEC-BUTYLBENZENE
P-ISOPROPYLTOLUENE
N-BUTYLBENZENE
1,2-DIBROMO-3-CHLOROPROPANE (DBCP)
1,2,4-TRICHLOROBENZENE
HEXACHLORO-1,3-BUTADIENE
1,2,3-TRICHLOROBENZENE
A-average' value. NA-not analyzed. NAl-interlerences. J-estimated value. N-presumptive evidence of presence of material.
K-actual value •is known to be less than value given. L-actual value is known to be greater than value given. Li-material was analyzed for but not detected. the number is the minimum quantitation limit.
R-qc indicate:; that data unusable. compound may or may not be present. resampling and reanalysis is necessary for verification. Page 1 of 1
-----------~ ~-----VOLATILES SAMPLE ANALYSIS --·--

-

-
EPA -REGION IV SESD, ATHENS, GA -Sample 727 FY 2002 Project: 02-0116
VOLATILES SCAN
Facility: North Belmont PCE Site North Belmont, NC
Program:. SF
Id/Station: BLANK /TRIP BLANK
Media:TRIP BLANK-WATER
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
25.U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
25.U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
DICHLORODIFLUOROMETHANE
CHLOROMETHANE
BROMOMETHANE
VINYL CHLORIDE
CHLOROETHANE
TRICHLOROFLUOROMETHANE (FREON 11)
1, 1-DICHLOROETHENE (1, 1-DICHLOROETHYLENE)
1, 1,2-TRICHLORO-1,2,2-TRIFLUOROETHANE (FREON 113)
METHYLENE CHLORIDE
METHYL T-BUTYL ETHER (MTBEJ
ACETONE
CARBON DISULFIDE
METHYL ACETATE
1, 1-DICHLOROETHANE
CIS-1,2-DICHLOROETHENE
2,2-DICHLOROPROPANE
METHYL ETHYL KETONE
BROMOCHLOROMETHANE
TRANS-1,2-DICHLOROETHENE
CHLOROFORM
1,2-DICHLOROETHANE
1, 1, 1-TRICHLOROETHANE
CYCLOHEXANE
1, 1-DICHLOROPROPENE
CARBON TETRACHLORIDE
BROMODICHLOROMETHANE
METHYL ISOBUTYL KETONE
1,2-DICHLOROPROPANE
METHYLCYCLOHEXANE
DIBROMOMETHANE
TRANS-1,3-DICHLOROPROPENE
TRICHLOROETHENE (TRICHLOROETHYLENE)
BENZENE
DIBROMOCHLOROMETHANE
1, 1,2-TRICHLOROETHANE
Produced by: Allen, Frank
Requester:
Project Leader: GBENNETT
Beginning: 10/30/2001 06:00
· Ending:
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U · UG/L
5.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
CIS-1,3-DICHLOROPROPENE
BROMOFORM
. BROMOBENZENE
1, 1,2,2-TETRACHLOROETHANE
TETRACHLOROETHENE (TETRACHLOROETHYLENE)
1,3-DICHLOROPROPANE
METHYL BUTYL KETONE
TOLUENE
CHLOROBENZENE
1,1,1,2-TETRACHLOROETHANE
ETHYL BENZENE
(M-AND/OR P-)XYLENE
O-XYLENE
STYRENE
1,2,3-TRICHLOROPROPANE
O-CHLOROTOLUENE
P-CHLOROTOLUENE
1,3-DICHLOROBENZENE
1,4-DICHLOROBENZENE
1,2-DICHLOROBENZENE
1,2-DIBROMOETHANE (EDS)
ISOPROPYLBENZENE
N-PROPYLBENZENE
1,3,5-TRIMETHYLBENZENE
TERT-BUTYLBENZENE
1,2,4-TRIMETHYLBENZENE
SEC-BUTYLBENZENE
P-ISOPROPYL TOLUENE
N-BUTYLBENZENE
1,2-DIBROMO-3-CHLOROPROPANE (DBCP)
1,2,4-TRICHLOROBENZENE
HEXACHLORO-1,3-BUTADIENE
1,2,3-TRICHLOROBENZENE
A-average value. NA-not analyzed. NAl-interferences. J-estimated value. N-presumptive evidence of presence of material.
K-actual va'1u'e,is known to be less than value given. L-actual value is known to be greater than value given. LI-material was analyzed for but not detected. the number is the minimum quantitation limit.
R-qc indicate~ that data unusable. compound may or may not be present. resampling and reanalysis is necessary for verification. Page 1 of 1
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Appendix L
COM RCFU Resampling
Data
(T)
Q_
~ Q_
_J a: CIC w 0 w LL
E B
ff: ts) ....
(T)
Sample 2313 FY 2002 Pro]ecl: 02.-0296
VOLATILES SCAN
Facility: North Belmont PCE Sile North Belmont, NC
Program: SF
Id/station: NBPWMGDP /
Media:POTABLE WATER (,~, ru ,~ T ':.. ,:., .._ N ,.-?w I'> tr,:, v)
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
LOU UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
25.U UG/L
2.5U UG/L
5.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
25.U UG/L
1.0U UG/L
1.0U UG/L
0.89J UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
DICHLORODIFLUOROMETHANE
CHLOAOMETHANE
BROMOMETHANE
VINYL CHLORIDE
CHLOROETHANE
TRICHLOROFLUOROMETHANE (FREON 11)
1, 1-DICHLOROETHENE (1, 1-DICHLOROETHYLENE)
1, 1,2-TRICHLOR0-1,2,2-TRIFLUOROETHANE (FREON 113)
METHYLENE CHLORIDE
METHYL T-BUTYL ETHER (MTBE)
ACETONE .
CARBON DISULFIDE
METHYL ACETATE
1, 1-DICHLOROETHANE
CIS-1,2-DICHLOROETHENE
2,2-DICHLOROPROPANE
METHYL ETHYL KETONE
BROMOCHLOROMETHANE
TRANS-1,2-DICHLOROETHENE
CHLOROFORM
1,2-DICHLOROETHANE
1, 1, 1-TRICHLOROETHANE
CYCLOHEXANE
1, 1-DICHLOROPROPENE
CARBON TErRACHLORIDE
BROMODICHLOROMETHANE
METHYL ISOBUTYL KETONE
1,2-DICHLOROPROPANE
METHYLCYCLOHEXANE
DIBROMOMETHANE
TRANS-1 ,3-DICHLOROPROPENE
TRICHLOROETHENE (TRICHLOROETHYLENE)
BENZENE
DIBROMOCHLOROMETHANE
1, 1,2-TRICHLOROETHANE
Produced by: Allen, Frank
Requester:
Project Leader: GBENNETT
Beginning: 01/23/2002 09:1 O
Ending:
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.DU UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.DU UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.DU UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
ANALYTE
CIS-1,3-DICHLOROPROPENE
BROMOFORM
· BROMOBENZENE
1, 1,2,2-TETRACHLOROETHANE
TETRACHLOROETHENE (TETRACHLOROETHYLENE}
1,3-DICHLOROPROPANE
METHYL BUTYL KETONE
· TOLUENE
CHLOROBENZENE
1,1.1,2-TETRACHLOROETHANE ·
ETHYL BENZENE
(M-ANDIOR P-)XYl.ENE
0-XYLENE
STYRENE
1,2,3-TRICHLOROPROPANE
0-CHLOROTOLUENE
P-CHLOROTOLUENE
1.3-DICHLOROBENZENE
1,4-DICHLOROBENZENE
1,2-DICHLOROBENZENE
1,2-DIBROMOETHANE (EDB)
ISOPROPYLBENZENE
N°P ROPYLBENZENE
1,3,5-TRIMETHYLBENZENE
TERT-BUTYLBENZENE
1,2,4-TRIMETHYLBENZENE
SEC-BUTYLBENZENE
P-ISOPROPYLTOLUENE
N-BUTYLBENZENE
1,2-DIBROM0-3~HLOROPROPANE (DBCP)
1,2,4-TRICHLOROBENZENE
HEXACHLOR0-1,3-BUTADIENE
1,2,3-TRICHLOROBENZENE
"' w A-average value. NA-not anatyzed. NAl-interfercnoes. J-eslimaled value. N--presumplive evidence of presence or material. .
LL K-adual value is known to be less than vatue given. L~ctual value is known lo be greare, than value given. LI-material was analy~d for bul not detected. lhe numDer is lhe minimum quantitatk>n limit.
R-qc indicates that dara unusable. compo\Jnd may or may nol be present resampling and reanalysis is necessary for verification. Page 1 of 1
....
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2
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"
Sample 2314 FY 2002 Project 02--0296
VOLATILES SCAN
Facility: North Belmont PCE Sile North Belman~ NC
Program: SF
ld/Slalion: NBPWMGIN /
Media: POTABLE WATER
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.DU UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
1.0U UG/L
25.U UG/L
2.5U UG/L
5.0U UG/L
1.DU UG/L
1.0U UG/L
1.0U UG/L
25.U UG/L
1.0U UG/L
1.0U UG/L
3.2A UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
ANALYTE
DICHLORODIFLUOROMETHANE
CHLOROMETHANE
BROMOMETHANE
VINYL CHLORIDE
CHLOROETHANE
TRICHLOROFLUOROMETHANE (FREON 11)
1,1-DICHLOROETHENE (1, 1-D!CHLOROETHYLENE)
1, 1,2-TRICHLOR0-1,2,2-TRI FLU OROETHANE (FREON 113)
METHYLENE CHLORIDE
METHYL T-BUTYL ETHER (MTBE)
ACETONE
CARBON DISULFIDE
METHYL ACETATE
1, 1-DICHLOROETHANE
CIS-1,2-DICHLOROETHENE
2,2-DICHLOROPROPANE
METHYL ETHYL KETONE
BROMOCHLOROMETHANE .
TRANS-1,2-DICHLOROETHENE
CHLOROFORM
1,2-DICHLOROETHANE
1,1.1-TRICHLOROETHANE
CYCLOHEXANE
1, 1-DICHLOROPROPENE
CARBON TETRACHLORIDE
BROMODICHLOROMETHANE
METHYL ISOBUTYL KETONE
1,2-DICHLOROPROPANE
METHYLCYCLOHEXANE
DIBROMOMETHANE
TRANS-1,3-DICHLOROPROPENE
TRICHLOROETHENE (TRICHLOROETHYLENE)
BENZENE
DJBROMOCHLOROMETHANE
1, 1,2-TRICHLOROETHANE
Produced by: Allen, Frank
Requester:
Projeci Leader: GB ENNETT
Beginning: 01/23/2002 08:45
Ending:
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UGIL
2.5U UGIL
1.0U UG/L
1.0U UG/L
1.0U UG/L
1,0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.ou UGJL
1.0U UG/L
1,0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U · UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
5.0U UG/L
ANALYTE
CIS-1,3-DICHLOROPROPENE
BROMOFORM
BROMOBENZENE
1, 1,2,2-TETRACHLOROETHANE
TETRACHLOROETHENE (TETRACHLOROETHYLENE)
1,3-DICHLOROPROPANE
METHYL BUTYL KETONE
TOLUENE
CHLOROBENZENE
1, 1, 1,2-TETRACHLOROETHANE
ETHYL BENZENE
(M-AND/OR P-)XYLENE
0-XYLENE
STYRENE
1,2,3-TRICHLOROPROPANE
0-CHLOROTOLUENE
P-CHLOROTOLUENE
1,3-DICHLOROBENZENE
1,4-DICHLOROBENZENE
1,2-DICHLOROBENZENE
1,2-DIBROMOETHANE (EDB)
ISOPROPYLBENZENE
N-PROPYLBENZENE
1,3,6-TRIMETHYLBENZENE
TERT-BUTYLBENZENE
1,2,4-TRIMETHYLBENZENE
SEC-BUTYLBENZENE
P-ISOPROPYLTOLUENE
N-BUTYLBENZENE
1.2-DIBROM0-3-CHLOROPROPANE (DBCP)
1,2,4-TRICHLOROBENZENE
HEXACHLOR0-1,3-BUTADIENE
1,2,3-TRICHLOROBENZENE
o:l A-average value. NA-flot analyzed. NAl-lnlerferenoes. J-eslimaled value. N-presumptive evidence or presence of malerial. , ~ K-actual value ts known to Ile less lha11 value given. l-actual tJalue IS known lo Ile grealer than value given. U-materia1 was analy~ed ror but not delecied. Ut~ number is Ule mfn[mum quantifalron limit.
R-qc indiCilles lhal data unusabJe. compound may or may not be present resampling and reanalysis is necessary for verification. Page 1 of 1
.--<
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M
Sample 2315 FY 2002 Project: 02-0296
VOLATILES SCAN
Facilily: North Belmont PCE Stte North Belmont, NC
Program: SF
Id/Station: NBPWMGOU /
Media: POTABLE WATER
RESULTS
1.0U
1.0U
1,0U
1.0U
1.0U
1.0U
1.0U
1.0U
5.DU
1.0U
25.U
2.5U
5.0U
1.0U
1.0U 1.ou
25.U
1.0U
1.0U
0.99J
1.0U
1.0U
1.0U
1.0U
1.0U
1.0U
2.SU
1.0U
1.0U
1.0U
1.0U
1.0U
1.0U
1.0U
1.0U
UNITS
UG/L
UG/L
UG/L
UG/L
UG/L
UGIL
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/1.
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UGIL
UG/L
UG/L
UGJL
UG/L
UG/L
UG/L
UG/L
ANALYTE
DlCHLORODIFWOROMETHANE
CHLOROMETHANE
BROMOMETHANE
VINYL CHLORIDE
CHLOROETHANE
TRICHLOROFLUOROMETHANE (FREON 11)
1, 1-DICHLOROETHENE (1, 1-0ICHLOROETHYLENE)
1, 1,2-TRlCHLOR0-1,2,2-TRIFLUORO ETHANE (FREON 113)
METHYLENE CHLORIDE
METHYL T-BUTYL ETHER (MTBE)
ACETONE
CARBON DISULFIDE
METl-lYL ACETATE
1, 1-DlCHLOROETHANE
CIS-1,2-DICHLOROETHENE
2,2-DICHLOROPROPANE
METHYL ETHYL KETONE
BROMOCHLOROMETHANE
TRANS-1,2-DICHLOROETHENE
CHLOROFORM
1,2-DICHLOROETHANE
1,1, 1-TRICHLOROETHANE
CYCLOHEXANE
1,1-DICHLOROPROPENE
CARBON TETRACHLORIDE
BROMODICHLOROMETHANE
METHYL ISOBUTYL KETONE
1,2-DICHLOROPROPANE
METHYLCYCLOHEXANE
DIBROMOMETHANE
TRANS-1,3-DICHLOROPROPENE
TRICHLOROETHENE (TRICHLOROETHYLENE)
BENZENE
DIBROMOCHLOROMETI--!ANE
1,1,2-TRlCHLOROETHANE
Produced by: Allen, Frank
Requeslor.
Project Leader: GBENNETT
Beginning: 01/2312002 09:05
Ending:
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/1.
1.0U UG/L
1.0U UG/L
2.5U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L.
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.DU UG/L
5.0U UG/L
ANALYTE
CIS-1,3-DICHLOROPROPENE
BROMOFORM
BROMOBENZENE
1, 1,2,2-TETRACHLOROETHANE
TETRACHLOROETHENE (TETRACHLOROETHYLENE)
1,3-DICHLOROPROPANE .
METHYL BUTYL KETONE
TOLUENE·
CHLOROBENZENE
1,1, 1,2-TETRACHLOROETHANE
ETHYL BENZENE
(M-AND/OR P-)XYLENE
0-XYLENE
STYRENE
1,2,3-TRICHLOROPROPANE
0-CHLOROTOLUENE
P-CHLOROTOLUENE.
1,3-0ICHLOROBENZENE
1,4-DICHLOROBENZENE
1,2-DICHLOROBENZENE
1,2-DIBROMOETHANE (EDB)
ISOPROPYLBENZENE
N-PROPYLBENZENE
1,3,5-TRIMETHYLBENZENE
TERT-BUTYLBENZENE
1,2,4-TRIMETHYLBENZENE
SEC-BLITYLBENZENE
P-ISOPROPYL TOLUENE
N-BUTYLBENZENE
1,2-DIBROM0-3-CHLOROPROPANE (OBCP)
1,2,4-TRICHLOROBENZENE
HEXACHLOR0-1,3-BUTADIENE
1,2,3-TRICHLOROBENZENE
E} A-average value. NA-nol analyzed. NAl-intederenoes. J-esfimated.va[ue. N-presumptive evidence or presence of malerial.
LL K-aclua1 value ls know11 to be less than value given. l-actuat value is known lo be greater than value given. U-ma(erlal was analy}:ed for bul not detected. lhe number is lhe minimum qLrantilarion fimil
·, R-qc Indicates that data unusable. compound may or may nol be present. resamp(in!) ancl reanalysis is necessary for we1ification. Page 1 of 1
<.I)
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Sample 2316 FY 2002 Project: 02-0296
VOLATILES SCAN
Facilily: North Belmonl PCE Sile
Program: SF
North Belmonl, NC
ld/Slalion: NBPWTB /
Media:TRtP BLANK· WATER
RESULTS UNITS
1.0U
1,0U
1.0U
1.0U
1.0U
1.0U
1.0U
1.0U
5.0U
1.0U
25.U
2.5U
5.0U
1.0U
1.0U
1.0U
25.U
1.0U
1.DU
1.0U
1.DU
1.DU
1.0U
1.0U
1.0U
1.0U
2.5U 1.ou
1.0U
1.0U
1.0U
1.0U
. 1.0U
1.0U
1.0U
UG/L
UG/L
UG/L
UG/L
UG/L
UG/l
UG/L
UG/L
UG/l
UG/l
UG/L
UG/l
UG/L
UG/L
UG/L :~g~
UG/l
UG/L
UG/L
UG/L
UG/L
UGJL
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
UG/L
· UG/L
UG/L
UG/L
ANALYTE
DICHLORODIFLUOROMETHANE
CHLOROMETHANE
BROMOMETHANE
VINYL CHLORIDE
CHLOROETHANE
TRICHLOROFLUOROMETHANE (FREON 11)
1, 1-DICHLOROETHENE (1,1-DICHLOROETHYLENE)
1, 1,2-TRICHLOR0-1,2,2-TRIFWOROETHANE (FREON 113)
METHYLENE CHLORIDE .
METHYL T-BUTYL ETHER {MTBE)
ACETONE
CARBON DISULFIDE
METHYL ACETATE
1, 1-DICHLOROETHANE
CIS-1,2-0ICHLOROETHENE
2,2-DICHLOROPROPANE
METHYL ETHYL KETONE
. BROMOCHLOROMETHANE
TRANS-1,2-DICHLOROETHENE
CHLOROFORM
1,2-DICHLOROETHANE '
1, 1, 1-TRICHLOROETHANE
CYCLOHEXANE
1, 1-DICHLOROPROPENE
CARBON TETRACHLORIDE
BROMODICHLOROMETHANE
METHYL ISO BUTYL KETONE
1,2-DICHLOROPROPANE
METHYLCYCLOHEXANE
DIBROMOMETHANE
TRANS-1,3-DICHLOROPROPENE
TRICHLOROETHENE {TRICHLOROETHYLENE)
BENZENE
DIBROMOCHLOROMETHANE
1,1,2-TRICHLOROETHANE
Produced by: Allen, Frank
Requeslor:
Project Leader: GBENNETT
Beginning: 01/23/2002 08:30
· Ending:
RESULTS UNITS
1.0U UG/L
1.0U UG/L
1.0U UG/l
1.0U UG/L
1.0U UG/L
1.0U UG/L
2.5U ' UG/l
1.0U UG/L
1.0U UG/L
1,0U UG/L
1.0U UG/l
1.0U UG/L
1.0U UG/l
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U UG/l
1.0U UG/L
1.0U UG/l
1.0U UG/L
1.0U UG/L
1.0U UG/L
1.0U . UG/l
1.0U UG/l
1.0U UG/l
1.0U UG/l
1.0U UG/L
1.0U UG/L
1.0U UG/l
1.0U UG/L
1.0U UG/l
5.0U UG/L
ANALYTE
CIS-1,3-DICHLOROPROPENE
BROMOFORM
BROMOBENZENE
1,1,2,2-TETRACHLOROETHANE
TETAACHLOROETHENE {TETRACHLOROETHYLENE)
1,3-DICHLOROPROPANE
METI-IYLBUTYLKETONE
TOLUENE
CHLOROBENZENE
1,1,1,2-TETRACHLOROETHANE
ETHYL BENZENE
(M-AND/OR P-)XYLENE
0-XYLENE
STYRENE
1,2,3-TRICHLOROPROPANE
0-CHLOROTOLUENE
P-CHLOROTOLUENE
1,3-DICHLOROBENZENE
1,4-DICHLOROBENZENE
1,2-DICHLOROBENZENE
1,2-DIBROMOETHANE (EDB)
ISOPROPYLBENZENE
N-PROPYlBENZENE
1,3,5-TRIMETI-IYLB ENZENE
TERT-BUTYLBENZENE
1,2,4-TRIMETHYLBENZENE
SEC-BUTYLBENZENE
P-ISOPROPYL TOLUENE
N-BUTYlBENZENE
1,2-DIBROM0-3-CHLOROPROPANE (DBCP)
1,2,4-TRICHLOROBENZENE
HEXACHLOR0-1,3-BUTADIENE
1,2,3-TRICHLOROBENZENE
Ol w A-average value. Nlklo1 analyzed. NAl-inlerferences. J-esUmated value. N-presumpUve evfdence of presence of materi.ir. ,
u... K-actual value is knowr, lo be less lhan varue given. L-aclual value is known to be greater than value given. U-materiaf was an:aly'Led for but nol detected. !he number ls lhe minimum quanlitation llmtt.
R-qc Indicates lhat da1a unusable. compound may or may not be present. resampling and reanatysis is necessary for verification,
Page 1 ol 1
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AppendixM
We.11 Abandonment
Forms
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:.,ri ~· V I<..) ,_, I North Carolin.i -Dcp.Jitment of Environment a.nd Nlrurll Resources -Division of Water Qulliry -GroundwJ:cr Section -16)6 Mlil S,rvice Ccn<<r • Ral<igh, NC 27699-1639. Phone No. (919) 7JJ-J221
\VELL ABANDONMENT RECORD WELL CONTRACTOR llfew~::l ~
WELL CONTRACTOR CERTIFICATION• -'Z..---"Z..LI.._.S.__---'-. ___ _
I. WELL USE (Check Applicable Box): Residential J-Munidpal □ Industrial□ Agricultural□ Monitoring□ Recovery □ Heal Pump Water Injection O Other □ If Other, List Use: _____________ _
2. WELL LOCATION: (Show a sketch of the location on back of fonn.) /" _,, P r.-7\ •
1 Nearest Town: FelAtW r~ County ~.,,., ~/1../ 11.J 7.Mifl};.,5 _.,c,;a:-~-{ft?//Jt.()A/L ---'--------
(Road Name and Number, Community, Subdivision, Lot No.)
3. OWNER: JAfttCf,. &_/4z
4. ADDRESS: /J.? 7Jf?/JU.S 6lc
5. TOPOGRAPHY: draw, slope, hilltop, val!~ • (circle one) 6. TOT AL DEPTH: .5'9 2. . DIAMETER · ~ ,.,.
7. CASING REMOVED:
fut.
'Z...
diameter
&'i'
8. DISINFECTION: #Tfl ft_ C!.-vP
(Amount of70% hypochlorite used:) V
9. SEALINGMATERIAL:
~ac;: r:r::~nt ' d-¥
gallons ofwate;:tz;;z_
Saad Ccrorol
bags of cement. __ _
gallons of water __
~material 8'~ 7JC.5 'Ji'ed:f,4
Amount'-----------------
10. EXPLAIN METIIOD EMPLACEMENT OF MATERIAL • .o~LJ2... c.lL~12r u✓«&e T@uC t I
11. DATE WELL ABANDONED
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the well showing total depth, depth and diameter of screens remaining In the welt, gravel interval,
intervals of casing perforations, and depths and types of fill materials used.
ccordanc \ SA NCAC 2C, well construction
WELL LOCATION: Draw a location sketch on the reve~e of this sheet, showing the _direction and distance of the well to at least two (2) nearby reference points such as roads, intersections and streams. Identify roads witli State Highway ro.ad identification numbers.
Submit origi~al to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days from completion of abandonment.
GW-30 Revised I 219_9
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I North Carolina -Department of Environmcnc and Na.rural Resources -Division of \Yater Quality -GrQundwater Section -1636 Mail
Service Center• RAieigh, NC 27699-1639 -Phone No. (919) 733·3~1 ·
I .. '\-YELL ABANDONMENT RECORD WELL coNTRACToR ./11 et&i( & s £.c.
. . WELL CONTRACTOR CERTIFICATION # 2-2-1 .S-
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I. WELL USE (Checlc Applicable Box): Residential ~nicipal D Industrial D Agricultural O Monitoring □
Recovery □ Heal Pump Water Injection □ Other □ If Other, Lisi Use: ______________ _
2. WELL LOCATION: (Show a slcetch of the location on baclc of form.)
Nearest Town: ~ff /1,U>,..s I County -1.fusc-></4[-'-"--,._n)A)-""--=-------
. IO 7 L/.fat1tts 8 Dz..
(Road Nanie and Number, Community, Subdivision, Lot No.)
3. OWNER: 6v l-/11A-;ev;A)
4. ADDRESS:.--£/..!:~c....7L.__L/Lf:.!M:!::::L/1t/tf!!L:C-'..l_Lh_L..L'/..6.t~-~-
5. TOPOGRAPHY: draw, slope, ~illtop, valley~ · · d (cuclconc) . I
6. TOTAL _DEPTII: /p~ . DIAMETI\R--=2-__ _
7. CASING REMOVED:
fw
2,.... "
diameter
8. DISINFECTION: -.../.l.-"--hL.L..1<..::..f/-;__-'k,c.;,:Z~...:tf!c.......,--'r''-----
(Amount of 70% h;,,;i;;;hlorite used:) I
9. SEALING MATERIAL:
Neat Cement
bags of cement J 2-
gallons of water q
Othcx:
Saad Cement
bags of cement. __ _
gallons of water __
Type material. ______________ _
Amount. ________________ _
.J 0. EXPLAIN METiiOD EMPLACEMENT OF MATERIAL.
--pzuu111.te rue
11. DATE WELL ABANDONED __..Cc,.l~h..::2:..e0c-,Z'-"'--'2--'----~ / .
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing Iola! depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
I do hereby certify that this well was abandoned in accordance wi
standards, and that a copy of the record has been "de the well own
. Signature of person abandoning the wclll_/.~.J{.=<Q:.L_..'.:~:..-:.._.~:::.Js.-::t:.k~,.__Datc b 7ij,
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well lo al least two (2}nearby reference points such as-roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original lo the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 12/99
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North Carolina -Department of Environment and Narural Resources -Division of Water Quality -GrQundwater Section -16)6 Mail
Service Center• Raleigh, NC 27699-1639. Phone No. [phone] ·
\VELL ABANDONMENT RECORI> WELL CONTRACTOR /Jilt!.~/· $,,t,o J ..$:vc._
WELL ~ONTRACTOR CERTIFICATION# -z._ Z..( C
I. WELL USE (Check Ap~licablc Box): Residential e(" Municipal □ Industrial O Agricultural □ Monitoring O
Recovery □ Heat Pump Water Injection □ Other O If Olher, List Use:. _____________ _
2. WELL LOCATION: (Show a sketch of the location on back of fonn.)
Nearest Town: Je/,,,,ta,v-r County _...,,C,::.:,,,,_..'-'-=-J":'-"j,-V,'l/'-=::..=-,-------
Lo7 Z!fo/'tN F, TR;
(Road Name and Number, Community, Subdivision , Lot No.)
3. OWNER: fJA.u L -fJ14-1!!-J// N .
4. ADDRESS: /() 7· 71, t>&4S Gt:£
5. TOPOGRAPHY: draw, slope, hilltop, valley, flat
· -· · 1 (circle one) 11
6. TOTALDEPTII: /]0 -DIAMETER._&_. __
7. CASING REMOVED:
fut diameter ,,
8. DISINFECTlON: J./-1/1 I Cv/J
(Amount of70% hypochlorite used:) '
9. SEALING MATERIAL:
Neat Cement
bags of cement _/_2.. __
gallons of water R'j
Saad Cement
bags of cement __ _
gallons of water __
~
-Type material ]e,-.,./-. e,Lp..s
Amount ?oyc,s
10. EXPLAIN METHOD EMPLACEMENT OF MATERIAL.
I "/l ,t,l/'t/ c'._
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of lhe
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
qr1~U7vcf .[ V/tt~ue
(]_.__rPI!-/-Lr
I do hereby certify that this well was abandon in a ordance with 15A NCAC 2C, well construction
standards, and that a copy of the record has be ~ ded ' ~11 owne . / _/_
Signature of person abandoning the well A.,,-~ , "'. _.,--z....n Date~ l.-
WELL LOCATION: Draw a location sketch on_thc: reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby-reference points such as roads, intersections and.
streams. Identify roads with State Highway niad identification numbers.
' Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised JV99
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North Carolina a Department of Environment and Na.rural Resources -Division of\Vattr Quatity-GrQundwater Section~ 1636 Mail
Service Center-Raleigh, NC 27699-1639 -Phone No. [phone] ·.
\YELL ABANDONMENT RECORD WELLCONTRACTOR /11t!W/ Mj kc_
WELL CONTRACTOR CERTIFICA"flON # 2---2--/S---
I. WELL USE (Check Ap~licable Box): Residential ~unieipal □ Industrial □ Agricultural □ Monitoring D
Recovery □ Heal Pump Water Irijeclion □ Other □ If Other, List Use:. ______________ _
2. WELL LOCATION: (Show a sketch of the location on back of form.)
Nearest Town: 7$'e/Jt,f Pl'( r County-'-. ,,,t;::..:.A,..:..J--'-n-~..:.V _____ _
//(} 7')./IJ/iuf-5 /ZLr£ ·
(Road Name and Number, Community, Subdivision, Lot No.)
3. OWNER: fr/1 C~o/: ape . .
4.· ADDRESS: /10 tft{)f11A S r I Tl£
5. TOPOGRAPHY: draw~hilltop, valley, flat
· . ~in:le one) I
6. TOTAL DEPTH: 7J" . DIAMETER.---"2-__ _
7. CASING REMOVED:
fu.t z_ I
diameter
2--"
8. DISINFECTION: · · Hr# f1 ~#!-
(Amount of 70% hypochlorite us'rd:)
9. SEALINGMATERIAL:
Neat Cement
bags of cement / "),..
gallons of water 8f
OthCI:
Sand Cement
bags of cement. __ _
gallons of water __
Type material. _____________ _
Amount. ________ :__ _______ _
10. EXPLAIN METIIOD EMPLACEMENT OF MATERIAL.
77'/MAf-le ~
11. DATE WELL ABANDONED or/4~;_
Quadrani;le No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens· remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
tjtfo1,v-,,P Svlf'~
r(!.,vr~~z._,/
I do hereby certify that this well was abandoned ·n accordance ith lSA NCAC 2C, well construction
standards, and that a copy of the record has bee · d to the well o . / ~/
Signature of person abandoning the well,-/--A_;A..L..=~.i..:_~:......,l..l;&~.!,__---Date~ ·2-
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2fncarby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 1V99
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North CaroHna ~ Department of Environment and Na.rural Resources~ Division of Water Quality. Grqundwaccr Section• 1636 Mail
Service Center. -Raleigh, NC 27699-1639 -Phone No. [phone] ·
'\VELL ABANDONMENT RECORD WELL CONTRACTClR /J1 e._&-f/ Mf=' -h,lc_
WELL CONTRACTOR CERTIFICA'l:'ION # Z,Z-/ S-:--
1. WELL USE (Check Applicable Box): Residential QI(' Municipal □ Industrial □ Agricultural □ Monitoring O
Recovery O Heat Pump Water Injection O Other D If Other, List Use: ______________ _
2. WELL LOCATION: (Show .,a sketch of the location oil ba~k of form.) .
Nearest Town: Rd mo,--C · County (t4,r)T(j,A/ II 2---Clft>ll1ttf & «----=---------
(Road Name and Number, Community, Subdivision, Lot No.)
3. OWNER: S j-MLfjV ffRa,,0u ;;k_.·'
4. ADDRESS: //2 JH!)Mf/5 A Oz
5. TOPOGRAPHY: draw, slope, hilltop.iyalie.;<? flat
· 1 (circle oner==-· . . .1
6. TOTAL DEPTH: 'f/2--. DIAMETER '2--~--..,....-
7. CASING REMOVED:
fi:c.t
2...
diameter 2--u
Quadrangle No.
. WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
8. DISINFECTION: hh1:f: Jt z_... e,_,....,f-1 (Amount of70% hypochlorik used:)
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9. SEALINGMATERIAL:
Neat Cement
bags of cement Jk_
gal'.ons of water~
Sand Cement
bags of cement. __ _
gallons of water __
ruik
Type material ']?e,.,l-cAp
Amount '>:::U A-g S
~
10. EXPLAIN METHOD EMPLACEMENf OF MATERIAL. pov?, f1Lf 1. ""TJ1-£t"ll-lie.. q&out
~
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the.direction and distance
of the well to at least two (2fnearby.reference points such as roads, intersections and
streams. Identify roads with State Highway re.ad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner wilhin 30 days
from completion of abandonment.
GW-30 Revised I 2/99
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North Carolina. OcpartmCnt of Environment and Na.rural Rcs0:urcc.s • Division of \Vatcr'Quality -Gn;iundwa(er Section -1636 Mail
Service Center-Raleigh, NC 27699-1639 -Phone No. [phone] ·
'\VELL t\BANDONMENT ro::coRD WELL CONTRACTOR . /Jtc?..e&-// ,lf,,,wJ
WELL CONTRACTOR CERTIFICATION# Z Z-/$7:
I. WELL USE (Check Applicable Box}: Residential 0:' Municipal □ Industrial □ Agricultural □ Monitoring O
Recovery O Heal Pump Water Injection O Other D If Other, List Use:. _____________ _
2. WELL LOCATION: .w a sketch of the location on back of form.}
Nearest Town: /;::i:::/fl1-t?A/'T..... County MS: T<'.'.!A / /0£ 'T~MA-J ,F<T/£. -~~~~-----
(Road Name andNumber, Community, Subdivision , Lot No.) Quadrangle No.
3.0WNER: IZJM✓ jf4£,,€1S
4. ADDRESS: /() 5' Tt/0&11:~ rt rJZ
5. TOPOGRAPHY: draw, slope, hilltop, valley@._
. · (circle one) · ~I
6. TOTAL DEPTII: ,//45 . DIAMETER'---'{p""'----
7. CASING REMOVED:
~ diiimetcr (p ,,
8. DISINFECTION: fl:Tlf / ~
(Amount of70¾ hypochloriteuscd:
9. SEALING MATERIAL:
Neat Cement
bags of cement ~ J/
gallons of water / u !? '
Sand Cement
bags of cement. __ _
gallons of water __
~material 8edeL'c..,or
Amount ?f S: R {. s: 7
10. EXPLAIN METHOD EMPLACEMENT OF MATERIAL.
povlf.. fl.i'-/'J & IO., U1&11r<
1 I. DATE WELL ABANDONED t> ~/)~/2 2-
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing.perforations, and depths and
types of fill materials used.
o/ Rt) u ,N LJ .s <..J1€'fitc--e
(::"" t?,uTt>fL 2-.,
1 do hereby certify that this well was abandoned in accordance with [SA NCAC 2C, well construction
st~ndards, and that a copy of the record has b?f#ovi~ ~~we"r~ . ._
Stgnature of person abandoning the well {z.gc ~ Date~2-
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _dir~ction and distance
of the well to at least two ·(2)-nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment. _
GW-30 Revised JV99
~~ ('l(l'l,>,/"1 doo.rl' I ~~ ~ <:, I \ ~ ---ti? ··. -..A.~ ~-(""' I ~ ('-_,.. ~ I
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North Carolina -Department of Environment and Nanual Resources -Division of \Vatc:r Quality -GrQundwater Section -1636 Mail
Service Center-Raleigh, NC 27699-1639. Phone No. [phone] · · ·
\VELL ABANDONMENT RECORD . WELL CONTRACTOR ll1 tJ&,{/ Lf'X,,J ;l;;, "-
WELL CONTRACTOR CERTIFICATION # 'Z---2-l ,C
I. ~LL USE (Check Applicable Box): Residential ~unicipal □ Industrial □ Agricultural □ Monitoring □
Recovery .□ Heal Pu!"p Water Injection □ Other □ If Other, Lisi Use: _____________ _
(Road 11mc and N ber, Community, Subdivision , Lot No.)
3. OWNER: ll/1£01,0 1 12,e,l!A-.ed.
4.ADDRESS: /J."J: {',$~8 LA-N-e.
5. TOPOGRAPHY: draw, slope, hilltop, valley, flat
{ ~ci.rcle one) l.//l 6. TOTALDEPTH:_1J_D __ DIAMETER 2-;.,._ ··
7. CASING REMOVED:
.fi:.c.t /4 / diameter 2..1/"
. ¼
8. DISINFECTION: H-rH: / 'L---e,,.,pJ
(Amount of 70% hypochlorite used:)
9. SEALING MATERIAL:
Neat Cement
bags of cement ---gallons of-water ---
Sand Cement
bags of cement __ _
gallons of water __
~ matcrial.__,_~.....,..~~L1>-f'<b~k~~~[~' -
Amount'-------+\-'Jog,,__ rt:f,,.fd~~---
10. EXPLAIN MEmQD EMPLACEMENT OF MATERIAL. O-Ot->~ :::t:"l?vcJL oovfL '
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations; and depths and
types of fill materials used.
---J:fµ=::@=J,J-:_-=...0__,c~}v/l.-'-"-~-
2-/ C.AJ'~' eu-r &(_{
q~r/f 2--/
1 .~ 1~
1 '-t
~\I 'Z~
WELL LOCATION: Draw a location sketch on th~ reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
· streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Qualiiy, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised !V99
Jf~kD;<J/ k,(]7'
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North Carolina • Department of Environment and Narural Resources -Division of \Yater Quality -Grqundwatcr Section -1636 Mail
Service Center• Raleigh. NC 27699-1639. Phone No. [phone]
\VELL ABANDONMENT llECORD WELLCO~croa tl!/_t?~,(/ ;;f',,eo ✓ ..;z;:;c._.
WELL coNTRAcroa CERTIF1cA r10N, 2--2-1 r
1. WELL USE (Check Applicable Box): Residential a<'Municipal □ Industrial O Agricultural O Monitoring O
Recovery O Heal Pump Water Irijection □ Other O If Other, List Use:._.,..... ____________ _
2. WELL LOCATION: (Show a sketch of the location on back of form.)
Nearest Town: 1?e{ fl:l,OAl f'" c1o/ 5/ County _--={;::....:...115';:_:_1(...;.o_;,J _____ _ zeo~w
(Road Name and Number, Community, Subdivision , Lot No.)
3. oWNER: "'&es Sm l U . ·
4. ADDRESS: d: () 0 fl~eAJ ke UI (?{,A.}
5. TOPOGRAPHY: draw, slope, ~illtop, valley@
· (cm:le one) 1,
6. TOTAL DEPTH: ~ 2-1
. DIAMETER._'2.-__ _
7. CASING REMOVED:
fw
2c1
diameter
ti
8. DISINFECTION: l:+ t"l+ ~ ~
(Amount of 70% hypochlorite ustcf:)
9. SEALINGMATERIAL:
Neat Cement
bags of cement ) 'f
gallons of water o/ f
Otha
Saad Ccrncoi'
bags of cement. __ _
gallons of water __
Type material, _____________ _
Amount. ________________ _
10. EXPLAIN METIIOD EMPLACEMENT OF MA1ERIAL.
TJl t MM;/ f ff:/le:vr'
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
Cjll.&tfav.0 S uR&.-<
~ e,..,_,-6-ll-
LI' .
I 11. DATE WELL ABANDONED b {zs;/4 2-
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WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2)nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised I V99
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North Carolina. Department oC Environment and Narural Resources• Division of \Yater Quality• Grqundwater SCCtion • 1636 Mail Service Center• Raleigh, NC 27699-1639. Phone No. [phone]
'\VE~L ABANDONMENT RECORD WELL CONTRACTOR /YI t! WI ~ .£.,_
WELL CONTRACTOR CERTmCATION • z 2-1 C
I. WELL USE (Check Applicable Box): Residential ~nicipal □ Industrial 0 Agricultural O Monitoring D Recovery □ Heat Pump Water Injection □ Other □ If Other, List Use: ______________ _
2. WELL LOCATION: Show a sketch of the location on back offonn.)
Nearest Town:__,~:,c;(..LJ~~~;:---------County _...._&.._· -'-A-,_5c....c...~-=-'--------
(Road Name and Number, Cornmu , Subdivision , Lot No.)
3. OWNER: /{o L/J-./Jt}
4. ADDRESS: / . ~SL!._L__.J.---2£2!.:'.'.£!~~~--
5. TOPOGRAPHY: draw, slope, hilltop, valle.,,...==--
. (circle one) , , 6. TOTAL DEPTII: j' L . DIAMETER_-'-2.-__ _
7. CASING REMOVED:
~ diameter -z,''
8. DISINFECITON: II T/I fz.._ ~
(Amount of 70% hypochlorite used:)
9. SEALING MATERIAL:
Neat Cement .
bags of cement / 2-
gallons of water £'1/
Sand Cement
bags of cement'----
. gallons of water __
~ material 1::---J ceftr
Amount I() >
10. EXPLAIN M~ EMPLACEMENT OF MATERIAL.
pv/t. ~ :J?Zr/4/f,ll( re
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used. d /J
[/t,wrrcX ,Jv,t!l-ne.e
-t>££_ ~~/
~l
\~ ' ~
1~ . 1-
WELL LOCATION: Draw a location sketch on the.reverse of this sheet, showing the _dir~ction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised IV99
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North Carolina -Dc:pactmc:nt of Environment and Natural Resources -Division of \Vatcr Qualiry-Grqundwatcr Section -16)6 Mail
Sc:rvice Center-Raleigh, NC 27699-1639. Phone No. [phone] ·
'\VELL ABANDOM\1ENTRECOlID WELL CONTRACTOR mcCA/7 &s 4,c
WELL CONTRACTOR CERTIFICATION# 2.'Z-/S-:-
1. WELL USE (Check Applicable Box): Residential ~nicipal □ Industrial O Agricultural O Monitoring O
Recovery □ Heat Pump Water Injection □ Other D If Other, List Use: ______________ _
2. WELL LOCATION: (Show a sketch of the location on baclc of fonn.)
Nearest Town: County _-'G=-A-~S_r.....;;o_A..I...:..... _____ _
(Road Name and ber, Community, Subdivision , Lot No.)
3.oWNER: J/-AzeL .S/!M 6 c2
4. ADDRESS: //, . {k>LJ1( LANI£..
5. TOPOGRAPHY: draw, ~i\)top, valley, flat
• · ~n:le one) I
6. TOTAL DEPTH: 3'8" ·. DIAMETER_·_2.. __ _
7. CASING REMOVED:
fu.t
2-
diameter -
Z-''
8. DISINFECTION: ff rlr f; c,,,_, P
(Amount of70% hypochlorite used:) t1
9. SEALINGMATERIAL:
Neat Cement
bags of cement --11::;_,_
gallons of water~
'Otha
Sand Cement
bags of cement'----
gallons of water __
Type material. ______________ _
Amount. ________________ _
10. EXPLAIN METHOD EMPLACEMENr OF MATERIAL. -r--e //WMIC ov10vC J
11. DATE WELL ABANDONED O 2...-/41 /4 2.... ~-_,, ..... ~,.,._ -----
· Quacltangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval, .
intervals of casing perforations, and depths and
types of fill materials used. ·
1 /lOV/J!J
f C,vr i,--U, 2.-I
~ \ ' ~
~'-~ .... ~ ~
\J
" (
~ ~
'<'..~~ ')
I do hereby certify that this well was abandoned in accordance wi
standards, and that a copy of the record has bee to the well o
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the ,direction and distance
of the well to at least two (2)nearby reference points such as roads, intersections and
streams. Identify roads with State Highway ro.ad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised I 2199
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North Carolina -Department of Environment and Nanual Resources -Division of\Vatcr Quality-GrQundwatcr Section -1636 Mail
Service Cen<er • Raleigh, NC 27699-1639. Phone No. [phone] , ,
\VELL ABANDONMENT RECOIID WELLCONTRACTOR lfl.t2thi(. &, _;;.,
WELL CONTRACTOR CERTIFICATION# ::Z.2. / s::
I. WELL USE (Check Applicable Box): Residential 19-"""Municipal D Industrial D Agricultural D Monitoring O
Recovery O Hea_l Pump Water Injection D Other D If Other, List Use: __ · ____________ _
2. WELL LOCATION: (Show a sketch of the location on back of fonn.)
Nearest Town: y:eftuo,,-C County _..,Gt..:A-=s.:.ro.c::.:,J _______ _
d)J-0( ~ .
· (Road Name and Number, Community, Subdivision, Lot No.) Quadrangle No.
3. OWNER: {!_tf-A,UD[IC L-e E'..
4. ADDRESS: 2 2...0 I A-cM :(
5. TOPOGRAPHY: draw, slope, hilltop, valley~
, · · 1 (cirde one) //'
6. TOT AL DEPTH: / (J 2. ·, DIAMETER._?~--
7. CASING REMOVED:
frci
2-'
diameter y,,
8. DISINFECTION: Hr# ?,_2 a4-
(Arnount of70% hypochlorite used:)
9. SEALING MATERIAL:
Neat Cement
bags of cement //? Sand Cement
bags of cement. __ _
. gallons of water / 2,(e gallons of water __
O!hc.c
Type material~--------------
Amount ·-----------------
I 0. EXPLAIN METiiOD EMPLACEMENT OF MATERIAL.
--T41M.M4~ t@ uC
11. DATE WELL ABANDONED-4()~2---~iC-'oCL1-,k....,o._'='---r /
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth; depth and diameter of
screens remaining in the well, gravel interval,
· intervals of casing perforations, and depths and
types of fill materials used.
I do hereby certify that this well was abandoned in accordance w"th !SA NCAC 2C, well construction
standards, and that a copy of the record has been rovid to the well o -
Signature of person abandoning the well (_ Date O ~/47j 2,...
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2fnearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 12/99
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North Carolina -Department of Environment and Natural Resources -Division of\Vatcr Qualicy..: Grqundwaccr Section-1636 Mail
Service Center-Raleigh, NC 27699-1639 -Phone No. [phone] ·
\VELL ABANDONMENT RECORD WELL CONTRACTO_R l}/e C<!//ZwJ ~
WELL CONTRACTOR CERTIFICATION# ~-r
1. WELL USE (Check Applicable Bo~): Residential ;;-;;.:nicipal □ Industrial D Agricultural □ Monitoring □
Recovery D Heat Pump Water Injection □ Other O If Other, List Use:. _____________ _
2. WELL LOCATION:..(.SJ!,ow!sketch of the location on back of form.)
Nearest Town: k!L!!. D/V r County _-={;=-A-_s_n:_.J ______ _
// 7 TH-O&tA-6 C? r/C.
(Road Name and Number, Community, Subdivision , Lot No.) Quadrangle.No.
3. OWNER:.____,l<L..J..L..3.Af~S=...L.[½.:...<f_,_Y,..::.,..._ ____ IF=========
·7· . --WELL DIAGRAM: Draw a detailed sketch of the
4. ADDRESS: _ __,/'--'/'-'.___T)-<-:"/lo.:..:c....:.IU..;..:.;M...:.;:._.c.P,-'-/--"Yt,--'~=--well showing total depth. depth and diameter of
5. TOPOGRAPHY: draw, slope, hilltop, valley, flat
· · · ? (cir<:lc one) r
6. TOTAL DEPTH: .:, ZS . DIAMETER /,:,
7. CASING REMOVED:
fw 2.;t
-=----
diameter
(;,"
8. DISINFECTION: rl-rfl-L (!...Jp
(Amount of 70% hypochlorite used:) /
9. SEALINGMATERIAL:
Neat Cement .. £
bags of cement · ') t
gallons of water / t,,J:
Othct.
Type material 3 0 ]?C.5
Amount SJ> .tf.-: ~ t;, ,
Sand Cement
bags of cement. __ _
gallons of water __
10. EXPLAIN METHOD EMPLACEMENT OF MATERIAL.
pov& ci.-, f' Tf2..LM,Y'{' 1J4vC
11. DATE WELL ABANDONED (J~ /4,. /o 2-r 1
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
,-
\. ~\
{~
~~ ~ ~
1 fl;, V 1'>~ 5-v;Z '1,e.e.
~ ev-r ~ 2.,/
()
(J
l" --....
I do hereby certify that this well was abandoned in accordance with 15A NCAC 2C, well construction
standards, and that a copy of the record has becnr~tft well owne
Signature of person abandoning the well--1C-£i~~,,4?--"'~-b-'-..1.~:.......'_..::__.c....;:::...;=--"---"
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2Ynearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Waler Quality, Groundwater Section, one copy to the 0IVl)cr within 30 days
from completion of abandonment.
GW-30 Revised !2199
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Nonh Carolina -Department of Environment and Narural Resources -DivisiOn of Water Quality• Groundwater Sc::ciion · 1636 Mail
Senicc Center• Raleigh, NC 27699-1639·· Phone No. [phone]
\YELL ABANDONMENT RECORD WELLCONTRACT9R M (!th-11 ¼f ...%:e.
WELL CONTRACTOR CERTIFICATION J 'Z-2-I S--
I · 1. WELL USE (Checlc Applicable Box): Residential ~nicipal □ Industrial □ Agricultural □ Monitoring □
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Recovery □ Heat Pump Water Injection □ Other □ If Other, List Use: _____________ _
2. WELL LOCATION: (Show a sketch of the location on baclc of form.)
Nearest Town: ::J :e \ rvt ov r . County _-""0'-'A'-'--'-S._Ti:.._i:>_.v ______ _
\\ la TJ:,~-e MA:> F l:[ E
(Road Name and Number, Community, Subdivision, Lot No.) Quadrangle No.
3. OWNER: N:c: 0 ..
4. ADDRESS: \1 L, t l,,k) MA:f f Li ff;
5. TOPOGRAPHY: draw, slope, hilllop, valle~
1 -£-' (circDleIAMETEone) R ,., 1~ ii 6 .. TOTAL DEPTII:_U?___ <>'I
7. CASING REMOVED:
fut
;l I
diameter ") '-f' (
8. DISINFECTION: 1+,f-f--) ~
(Amount of70% hypochlorite used:)
9. SEALING MATERIAL:
Neat Cement
bags of cement ---gallons of water ---
Sand Cement
bags of cement'----
ga!lons of water __
Q.thc!:'
Type material._U=cc../\J_Ut-_e,_k-=-~17-~ ....... -(_ __
Amount _______ -il-i:gL'-#--=;~;t-,1_=='-. __ _
·. 10. EXPLAIN METIIOD EMPLACEMENT OF MATERIAL.
~ m~. ~~
I I. DATE WELL ABANDONED (? .;_ / 0 Yr L.. I
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths_ and
types of fill materials used.
I do hereby certify that this well was abandoned in accordance wi 15A NCAC 2C, well construction
standards, and that a copy of the record has
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the.direction and distance
of the well to at least two (2fnearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW. 3 0 Revised 12199
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North Ca..olina • Department of Environment and Narural Resources• Division of Water Quality. GrQundwater Section• 1636 Mail
Service Center-Raleigh, NC 27699-1639 -Phone Na. [phone] ·
\VELL ABANDONMENT RECORD wELL coNTRACToR &f eCfll. k .:;t:;..,~
. . WELL CONTRACTOR CERTIFICA 'flON # 2.2.1 L
I. WELL USE (Check Applicable Box): Residential ~unicipal O Industrial O Agricultural O Monitoring D
Recovery O Heat Pump Water bijection O Other O If Other, List Use: ______________ _
2. WELL LOCATION: (Show a sketch of the location on back of form.)
. Nearest Town: 7:'r (Me>µ; .· County -"~"'-'-,1-'-S-'r._::_cJ_,,J ______ _
c:24'-:A. ,v. t'e,,,i b<c?11 6(t..v:
(Road Name and ¥ru°mber, Community, Subdivision , Lot No.) Quadrangle No.
3; OWNER:. __ .·_::j,<,::<ll....'...JbCL.I.ALI _J/Zt=::-'---J,V...;.t'~S..:..:N_.:al'.M<:!D,... ___ 11===========
4. ADDRESS:._.::,_;).._o_· _2.__:Yo....,_2.,~ ..... c...,,(&-J~-"~=~,e."°'t..,..J=--
5. TOPOGRAPHY: draw, slope, hilltop, valley@_ • . · q· · 1 (cin:lc one) · • ✓,
6. TOTAL DEPTH: 2 . DIAMETER 5 ·_..,:c. __ _
7. CASING REMOVED:
fw
2--'
diameter
'jl/
8. DISINFECTTON: )ff II-Yz.. ~
(Amount of 70% hypochlorite used:)
9. SEALING MATERIAL:
Neat Cement
bags of cement ___ 1 !f' ·
gallons ofwate~
Sand Cement
bags of cement. __ _
gallons of water __
Qlhci:
Type material, ____ _c.. ________ _
Amount. ______ _;_ _________ _
I 0. EXPLAIN ME"rnOD EMPLACEMENT OF MATERIAL.
"T(l,-L/f-1, /£1,/ ,f o/,/U}vr
. I I. DATE WELL ABANDONED __;:_~..:z._.~/4..!<t,:.:..f~Z_;_a,_'2--__
l '
I do hereby certify that this well was abandon
standards, and that a copy of the record has been pr ded
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
-
rdance with
llo
· qitv.JJl/'iSv/l~
~ /J-<,, 1 ~ 7..,;
. ·-" . WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the.direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised l 2/99
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North Carolina -Department of Environment and Nanual Resources· Division of\Vatcr Quality• GrQundwatc:r Section· 1636 Mail
Service Cen«, • Raleigh, NC 27699-1639. Phone No. [phone] ·
'\YELL ABJ\.NDONMENT RECORD WELL CONTRACTOR &W /2f;J ~
WELL CONTRACTOR CERTIFICA '!'ION# ;v? ~
1. WELL USE (Check Ap~licable Box): Residential ~cipal □ Industrial O Agricultural O Monitoring O
Recovery □ Heat Pump Water Injection □ Other □ If Other, List Use: ______________ _
(Road Name and Number, Community, Subdivision , Lot No.)
3. OWNER: ::kkc.J E re s ,tt£½!te
4. ADDRESS:._..::cd_..;;._0_.,}-:...:....._·-=Cec.:::.;_:,...,_leA. __ v_t e_t.v __ ,._
5. TOPOGRAPHY: draw, slope, hilltop, valle~
I·/.,.., t (circDle!AMone) ETE. R 2. l/ 6. TOTAL DEPTII: <------
7. CASING REMOVED:
fut
2,1
diameter Z. ,r
s. DrsINFEcnoN: /<frU-Yi 0-~
(Amountof 70% hypochloriie used:)
9. SEALING MATERIAL:
Nc3t Cement
bags of cement ..... [=S-,~·.,---
gallons of water / Z-(9 >
Olhcr
Sand Cement
bags of cement'----
gallons of water __
Type rnaterial'---------------
Amount'-----------------,
10. EXPLAIN METIIOD EMP~CEMENf OF MATERIAL.
:::t::& t i« 11<1 e °t,,t.o u [_ . .
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
11. DA TE WELL ABANDONED Q;? /4 I 2 z__,,.
I do hereby certify that this well las !ban one in accordance AC 2C, well construction
standards, and that a copy of the record has bee . ro · ed tojh
1
. e well o "'~ /_ /
Signature of person abandoning the well.+--,.4~~"'-=---[,;__ · ___ .:_.=:.,. ___ -"Date~ 2-
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the_dir~ction and distance
of the well to at least two (2)-ncarby reference points such as roads, intersections and
streams. Identify roads with State Highway ro.ad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 12/99
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North Carolina -Depactment of Environment and Narural Resources -Division of \Yater Qualiry -Grqundwatcr Section -1636 Mail
Service Center -Raleigh, NC 27699-1639. Phone No. (919) 733-Jlll ·
\VELL ABANI)ONMENT RECORD WELL CONTRACTOR /J;/e 4--// µ1 £c__
. WELL CONTRACTOR CERTIFICA '!'ION# 2.:Z. I ~
1. WELL USE (Check Ap~licable Box): Residential ~nicipal □ Industrial O Agricultural O Monitoring O
Recovery O Heat Pump Water Inj.ection □ Other □ If Other, List Use:. ______________ _
2. WELL LOCATION: (Show a sketch of the location on baclc of form.)
Nearest Town: ];'el (\Ao"' C County _-'C,"--A_s_T()l-.l ________ _
. iJ:J O'( A-c Me'
(Road Name and Number, Community, Subdivision, Lot No.)
3. OWNER: b (e-v J) 1\-
4. ADDRESS: d: {D 1
5. TOPOGRAPHY: draw, slope, hilltop, valley, flat · · · <u/ {circDleIAMonc) ·ETER /L. If 6. TOTAL DEPTH:._..c.t::J_._____ I.
7. CASING REMOVED:
fc.c.t 2' diameter 'f'I
s. DrsINFECTioN: M rH 1/2 ~p
(Amount of70% hypochloritc ~scd:) 1
9. SEALING MATERIAL:
Neat Cement
bags of cement I 2--
gallons ofwater-5i:f-
Othc.c
Saod Cement
bags of cement. __ _
gallons of water __
Type material'------~--------
Amount'-----------------
10. EXPLAIN METIIOD EMPLACEMENT OF MATERIAL. :r rt 1 111 t:t( < 1 M v::r:
11. DATE WELL ABANDONEO __:D::..::2-"-1-/4"'1'-+/4.,,_0_2--__ _ r,
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths.and
types of fill materials used.·
I do hereby certify that this well was abandoned in accordance w·th ISA NCAC 2C, well construction
slandards, and that a copy of the record has been P, to the well o
Signature of person abandoning the well'-hP.=.l,.<J...,;_....:..(_~_..::....-J:...s:2--=....:..---Date t> 1/4/2-
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Subm_it original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 1V99
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North Carolina• Department of Environment and Natural Resources• Division of\Vatcr QuJ.liry. Groundwater Section• 1636 Mail
Service Center• Raleigh, NC 27699-1639. Phone No. [phone] ·
\VELL ABANDONMENT RECORD WELL CONTRACTOR ·. /Ylq..(},..d P &+:> r,z::.:..
WELL CONTRACTOR CERTIDCATION # Z.Lt ½
1. WELL USE (Checlc Applic~ble Box): Residential Zunicipal □ Industrial □ Agricultural □ Moniloring □
Rccove,y □ Heat Pump Water Inj.ection □ Other D If Other, List Use:. ______________ _
=
2. WELL LOCATION: (Shpw a sketch of the location on back offonn.)
Nearest Town: 3'e,Lf1,Drr County _ _,, fb...::..:A...:...,.-[.,_TD_::::.:...,,J _____ _
11 ~ :t:no,Y-M f:" t re:.-
(Road ame and Number, Community, Subdivision , Lot No.)
J.OWNER:·P&1e{ope w,~/eg__
Quadrangle No.
4. ADDREss: / / 1/ 'Tl{cyt(A:f 8 rL
5. TOPOGRAPHY: draw, slope, hilltop, valley, flat
. · (cin:le one) I ,
6. TOTALDEPTII: :)./~ . . DIAMETER._ .. _2-__ _
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, ·gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
7. CASING REMOVED: . fcc.t diameter
2-"
8. DISINFECTION: . 1±:r:H: Y1 = ~r
(Amount of70% hypochlorite used:)
9. SEALING MATERIAL:
Neat Cement
bags ofcement""/:J.c._• __
gallons of watei t:r Sand Cement
bags of cement __ _
gallons of water __
~material l?e,,_sl--e-LpJ
Amount 2.0 3' l s
JO. EXPLAIN METIIOD EMPLACEMENT OF MATERIAL. f"'1= cL.fJ · 77t, ,..._m c qrlouC
11. DATE WELL ABANDONED --'17"-l'+l-"2--.'-"n_,x;~o~-2--~_ I I
WELL LOCATION: Draw a location sketch on .th~ reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby·refercnce points such as roads, intersections and
streams. Identify roads with State Highway ro_ad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised I V99
Tt"1o~r
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North Carolina -Department of Environment and Narural Rc:sotircc,s -Division of \Vacc·r Quality -Grqundwater Section -1636 Mail
Service Center-Rllleigh, NC 27699-1639 -Phone No. [phone] ·
'\YELL ABANDONMENT RECORD WELL CONTRACTOR /f!e{kl/ :}:ta J · :.z::__
WELL CONTRACTOR CERTIFICATION# _...;Z.=Z-:::...Lt_,_r ___ _
I. WELL USE (Check Applicable Box): Residential ~pal □ Industrial □ Agricultural □ Monitoring □
Recovery □ Heal Pump Water Injection □ Other D If Other, List Use:. ______________ _
:
2. WELL LOCATION: (Show a sketch of the location on back of fonn.)
Nearest Town: ~el (IA.= L County _~=A'-"=S'-'-Y...;6:c...,,J_, ------// fi: 5cZ ,;;:1--Sc_
(Road Name and Number, Community, Subdivision , Lot No.) Quadrangle No.
3. OWNER: /JDt,Ue,e ot /le >f#t f dv,ec/ i.==========
f ;; ·c;, · · <' _ / . ;_,.--WELL DIAGRAM: Draw a detailed sketch of the .
4. ADDRESS: (?L · ..JCflPO'--.S ~ well showing total depth, depth and diameter of
~ screens remaining in the well, gravel interval,
5. TOPOGRAPHY: draw, slope, ~illtop, valle~ intervals of casing perforations, and depths and
· · (circle one) -, , types of fill materials used.
6. TOTAL DEPTH: /0 'l.. . DIAMETER.___.,;),""·'-----'-
7. CASING REMOVED:
fut.
:) ..
diameter
rl-' I
8. DISINFECTION: _...,/±__,T,'-'(c.1..t_,_Y-_.?'---"e,...,-{J=-"'----
(Amount of 70% hypochlorite used:) -,-
9. SEALING MATERIAL:
Neat Cement
bags of cement~
gallons of water~.
S aod Cement
bags of cement._ __
gallons of water __
athcr f ~-Type material . ] &--' /?_ p!
Amount IQ U~ s ·
I 0. EXPLAIN ~OD EMPLACEMENT OF MATERIAL.
fOv/2-Cf ::VZ,M~e 1~ ·
11. DATE WELL ABANDONED () / /2.) /4 L-. r 7
-
I do hereby certify that this well was aban ne in accordance 11\.JL-n.C 2C, well construction
standards, and that a copy of the record has ed to the well o . ., , /. ,....,.. /
Signature of person abandoning the well . ~ Date~D 2._..,
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2)nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.'
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised IV99
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North Carolina -Department of Environment and Na.rural Resources: -Division of Water Qualiry-Grqundwater Section -16)6 Mail
Service Center-Raleigh, NC 27699-1639. Phone No. [phone] ·
'\VELL ABANDONMENT RECORD WELL coNTRAcroa-1-/J1.!....L·~e-=={}M'-'-'a..1__,_M"""-'""'%?""5'='-bJ-<-.-.-L.=....c..=-· _
WELL CONTRACTOR CERTIFICA 'f[ON # _..:2.ccZ-e:::.:.l..::.S:.._ __ _
1. WELL USE (Check Applicable Box): Residential.(] Municipal □ Industrial D Agricultural D Monitoring
Recovery D Heat Pump Water Injection D Other D If Other, List Use:. ________ '--------
2. WELL LOCATION: (Show a sketch of the location on back offonn.)
Nearest Town: :g e.[,neN r County _..=(',,::;_;_A_s_·_, _O_i>J..;__ ____ _ Jole CP,v k@.ne,...; ·
(Road Name and Number, Community, Subdivision, Lot No.) Quadrangle No.
i:--. P.A. 3. OWNER:._i:..f:::.~.-=--'-''----------~--A'=============
4. ADDRESS: :)() {p C,e<J kevrcw
5. TOPOGRAPHY: draw, slope, hilltop, valley~
· · · (circle one) 11 6. TOTAL DEPTii: / I (,, ·. DIAMETER.___.efe£..._ __
7. CASING REMOVED:
fci:.t a diameter ;;i If
8. DISINFECTION: /:t T It Yz_ C.,V p
(Amount of70% hypochlorite used:)
9. SEALING MATERIAL:
Neat Cement
bags of cement--;,\ -'2-.,....,._
gallons ofwate,r fi'j
Sand Cement
bags of cement. __ _
gallons of water __
~material,___~~e_,-.;""-''-'t-'----'~""'-..::..c.-F------
Arnount 3 ~ a. ,S
I 0. EXPLAIN METiiOD EMPLACEMENf OF MATERIAL. r D v/t. c.Au-p-' , '111 k MM I f l'.,-1),1.e,-'f"':
11. DATE WELL ABANDONED ______ _
I do hereby certify thai this well was aban
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
•
f/: (tbt.hv tJ Sv.,e fe<;,e_
~ (!.,v r r>JL 2 '
standards, and that a copy of the record has n r vid
Signature of person abandoning the welll_i.,,~:::'.~~.L.:1._~:._~~::1-_;,Date~ L
WELL LOCATION: Draw a location sketch on th; reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway rQad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 12/99
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North Caro Jina -Dcputmcnt cf Environment and Narural Resources · Division of Water Quality -Grqur\dwatcr Section · 16.36 Mail
Service Center -Raleigh. NC 27699-1639 -Phone No. [phone] ·
\VELLABANDQNMENTRECORD WELL CONTRACTOR-+/l1L . .1.-<JJ.<&-./;:>e:!:CIL . .,__1/_· _.7{;~,,e:o_::::::.·"-'! _;"-~•:::.;4:..:v:...::c.:_
WELL CONTRACTOR CERTIFICATION# _,..Z.=Z"""-'t..__.S-___ _
I. WELL USE (Check Applicable Box): Residential D Municipal D Industrial D Agricultural D MonitorinK'
Recovery D Heat Pump Water Injection D Other D If Other, Lisi Use: ______________ _
2. WELL LOCATION: (Show a sketch of the location on back of form.}
Nearest Town: 7!f?/1t1 {),vL · County _a__A-;~-S_n_l)A,1--'-_____ _
20fe C!-etUkreu1e.., 2
(Road Name and Number, Community, Subdivision , Lot No.) Quadrangle No.
3. OWNER:_...c.F::__,P__!,.A~-------,--F==========
4. ADDRESS: ;;J-0 °(< C.e',v kcu1r;,_,
5. TOPOGRAPHY: draw, slope, hilltop,valley@
· . · (circle one) · · '/" //
6. TOTAL DEPTH: / ?.J . DIAMETER /l-
7. CASING REMOVED: ·
fut :;..... diameter 'f: •I
8. DISINFECTION:_· -..l+lf~rt..L...J-'--_. t...r'l,.;,__,_·-'"'c-ve=J'-----
(Amount of 70% hn,ochlorite used:) ~
<
. 9. SEALING MATERIAL:
Neat CC:mcnt
bags of cemeni
gallons of water
/2--s:,y
·sand Cement
bags of cement. __ _
gallons of water __ .·_
~ material ')-<> } C. J J? e .,.,/--cf..;; J
Amount'-----------"---------
I 0. faLAfN JZ°° EMPLACEMENT OF MATERIAL.
. DVL {:. o.:r Pm1er« 1/Z6uC
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
--M
·-.........
11. DATE WELL ABANDONED 121hdo ~ r1
I do hereby certify that this well was abando d i A NCAC 2C, well construction
standards, and that a copy of the record has been p "de _ , /_ ,..... J
Signature of person abandoning the well_f_-r1b:::::'.ib.<~£i....::__f::_~~~{_ __ !Date~02-
WELL LOCATION: Draw a location sketch on tlie reverse of this sheet, showing the _direction and distance
of the well to at least two (2)nearby reference points such as roads, intersections and
streams. Identify roads with State Highway rqad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised I 2199
"--,
uetl ~x ->tee
t-,,-,0 ·,~
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North Carolina• Department o( Environment and Na.rural Resources• Division of Water Quality-GrQundwater Set:tion • 1636 Mail
Service Center• Raleigh, NC 27699-1639. Phone No. [phone] ·
\VELLABANDONMENTRECORD WELL CONTRACTOR . /Jte&..;1 MoJ ..;z:;,,c:. ~ ..
WELL CONTRACTOR CERTIFICATION# b2-J. C
I. WELL USE (Check Ap~licable Box): Residential Ef"Municipal D Industrial □ Agricultural □ Monitoring O
Recovery D Heal Pump Water Injection D Other □ If Other, List Use: _______ _;_ ______ _
2. WELL LOCATION: (Show a sketch of the location on back of form.)
Nearest Town: l3e fr,u,,-, r. County __ ~=.:A-:.!:5:c· .!.."°,=,-.) ______ _
2. 2..1 J ALM-'('._
(Road Name and Nu~ber, Community, Subdivision, Lot No.)
3. OWNER: 0 A-f. Lefile,e i'1&f
4. ADDRESS: 2-2... I 5 A--CJ1.Ve,,,
5. TOPOGRAPHY: draw, slope, hilltop, valley, flat · , i (circle one) l I
6. TOTAL DEPTH: lg (e . • DIAMETER :),'f
7. CASING REMOVED:
fcc.t
2.1
diameter d1/ I/
8. DISINFECTION: / e.-ure tf-rz-1-
(Amount of70% hypochlori~ used:)
9. SEALING MATERIAL:
Neat Cement Sand Cement
bags of cement ___ _ bags of cement. __ _
gallons of water ___ _ gallons of water __
~ material Flow;J t ~/ /
Amount , G ift) j 7;,
I 0. EXPLAIN METIIOD EMPLACEMENT OF MATERIAL • . ~k Tu,ucf;< Pov,:<.-
11. DATE WELL ABANDONED _ . .=6..L/-1-/4=2.,:;.,J/2c.....:...;o~=-"----7 ¥
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types _of fill materials used.
WELL LOCATION: Draw a location sketch on tl!e reverse of this sheet, showing the.direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway ro.ad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW -30 Revised 12/99
' ' ~ 1,i/ i I"
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North Carolina• Dcpactmc:nt of EnvirOnmcnt and Natural Resources.· Division of\Vatc:r Quality. Grqundwatc:r Section• 1636 Mail ·
Service Center• Raleigh, NC 27699-1639. Phone No. [phone] ·
\YELL ABANDONMENT RECORD . . . WELL CONTI!.ACTOR__,//A:..:.__.t1£.c,'J4/c...:....:.._(__:.7?.....:pc..,...._.> ____ _
WELL CONTRACTOR CERTIFICATION # _..:2-::.::2.c...L./ .,,_S-___ _
I. WELL USE (Check Ap~licable Box): Residential /4nicipal D Industrial D Agricultural O Monitoring D Recovery O Heat Pump Water Injection D Other O If Other, List Use: ______________ _
(Road Name and Number, Community, Subdivision , Lot No.)
3. OWNER: tp/J~ r f/Jc&;ef
4. ADDRESS: /2;). 'J Lf /I C/11 e__
5. TOPOGRAPHY: draw, slope, hilltop, valley, flat
• · · j O /<(circle one) · ✓ _L, I/
6. TOTAL DEPTH: lt?tJ . DIAMETER ;}.,L
7. CASING REMOVED:
fut
:;, I
diameter ,.;1:f "~
8. DISINFECTION: ·1:4:-rH:-J C!.-u ~
(Amount of 70% hypochlorite used:)
9. SEALINGMATERIAL:
Neat Cement
bags of cement ___ _
gallons of water ___ _
Sand Cement
bags of cement,__ __
gallons of water __
~ material f [-0 lJ ;J; /e_ ~ { {
Amount . I f ~ ,;;15 •
10. EXPLAlN METIIOD EMPLACEMENT OF MATERIAL.
{)wCflele ../tb ,llL f""IL
I I. DATE WELL ABANDONED OJ I z_if/4 2--f ry
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and _diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
, q /l,&, 1,->J. .f v ,ekc,e_
'z,t~f~ ~evr oP,
(}If i---..----i ~ I
I do hereby certify that this well was aba accordan e · NCAC 2C, well construction
standards, and that a copy of the record has
Signature of person abandoning the well,.lc,.L~..a.c::.:::__:::..:...._;:......!::::..J...:'.:_..::::. ___ Date,_.rL/.-+-=P
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the.direction and distance
of the well to at least two (2)nearby reference points such as roads, intersections and
streams. Identify roads with State Highway ro_ad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised !2199
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North·Ca.rolina -Department of Environment and Narural Resources -Division of\Vatcr Quality-GrQundwatcr Section -1636 Mail
Service Center• Raleigh, NC 27699-1639. Phone No. [phone] .· ·
\VELL ABANDONMENT_REcoRD wELLCOrfl'.RACTOR ;JJeuf(&,.) $c.
WELL CONTRACTOR CERTIFICA 'PON# Z.. 2-J .S
1. WELL USE (Check Applicable-Box): Residential ~nicipal □ Industrial □ Agricultural □ Monitoring □
Recovery □ Heat Pump Water Injection □ Other □ If Other, List Use: ______________ _
2. WELL LOCA TIOlt{Sho,)" a skc==' the location on back of form.)
Nearest To~: ::..J:: -e-( f\1.l?:1 1-County _..::Q=.!.A.>eS"=-..c.Y:_t1_,J _____ _ -~~ ~c,,etL (Roa arnttndNurnber, Community, Subdivision, Lot No.)
3. oWNER: E/leAI Wfhl7L
4. ADDRESS: 1/ i l<o,oe&
• < . f
5. TOPOGRAPHY: draw, slope, hilltop, valle:.;.<liat)
0 (circle one) JI
6. TOTAL DEPTII: Q? ·. DIAMETER.-"'?=----
7. CASING REMOVED:
fw diameter
k'I
8. DISINFECTION: t}rt-i f;__ C-'f
(Amount of70% hypochlorite used:)
9. SEALING MATERIAL:
Neat Cement ?-.
bags of cement . I /
gallons of water fl.
Sand Cement
bags of cement. __ _
gallons of water __
~ materiat,_"2-------"-. _'.i):____J}-=5=-~0.:=-,j_=-'f-1 __ _ Amount. ________________ _
10. EXPLAIN METJIOD EMPLACEMENT OF MATERIAL. pou ,z (!k...._p; 17?11i,1111,a? ravJi
11. DATE WELL ABANDONED _.J..f>wf'-L.z..::;1.,_~__,fec...:6~"2~=-/ l
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
~~ /v<t/!,a;
I do hereby certify that this well was abandoned in accordance AC 2(:i well construction
standards, and that a copy of the record has vi. d ~e well o
Signature of person abandoning the well,..\-...,,..e:::::......1..L..:......:.'-!:::.........:..~µ:::::....l. __ _
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to al least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway ro_ad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 1 V99
l.~ ~ ~~ ~
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North Carolina -Department oC Environment and Na.rural Resources -Division of.Water Quality -Grqundwater Section -1636 Mail
Service Center-Raleigh, NC 27699-1639 -Phone No. [phone] ·
\VELLABANDON1\1ENTRECORD WELLCONTRACTOR 4(/cCu! ~.J g:..:..
. . . WELL CONTRACTOR CERTIFICATION # 2-?-fo --
I. WELL USE (Check Ap~licable Box): Residential ;;:?u'nicipal □ Industrial D Agricultural D Monitoring D
Recovery O Heat Pump W_ater Injection D Other O If Other, List Use: ______________ _
(Road Name and Number, Comm 1ty, Subdivision, Lot No.)
3.0WNER: ()b,LL15 /Jf¾:4,,fs
4. ADDRESS:___!:3~~~~-/(_7.f..._/J.j~~-:JLJ_~:1.--
5. TOPOGRAPHY: draw, slope, hilltop, val1'1.l.<=.,
· . L4 (circle one)
6. TOTAL DEPTH: +°(e . DIAMETER___,._-"'---
7. CASING REMOVED:
fut
2-
diameter
Z-"
8. DISINFECITON: fl-Tlf ~ (? f
(Amount of70% hypochlorite used:
9. SEALING MATERIAL:
Neat Cement
bags of cement _/~'2--~-
gallons of water &:1
Sand Cement
bags of cement. __ _
gallons of water __
~ material.-ll'-"'0'--1?..µs.,.,-=-~-13~P--_·±L....J.c=4~'.)-Amount, ________________ _
10. EXPLAIN Mg&-0D EMPLACEMENT OF MATERIJ\L. rl)l?--•fj S'J]l1t11ttve ]A£
11. DATE WELL ABANDONED--"'/J_..~-1-/2-=z'-"<}:....f'-"'--L.----=---
I do hereby certify that this well was abandoned ·
standards, and that a copy of the record has b
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used. ·
-<::.
·th 15A NCAC 2C, well construction
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonmenl
GW-30 Revised I 2/99
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North Carolina• Department a( Environment and Na.rural Resources· Division of Water Quality• Grqundwatcr Section· 1636 Mail
Service Center-Raleigh, NC 27699-1639. Phone No. [phone] ·
\VELLABANDONMENTRECORD WELL CONTRACTOR .· /J{a~ ff .4o , . frc-
WELL CONTRACTOR CERTIFICATION • .z z.-1 r
I. WELL USE (Check Ap~licable Box): Residential J<!(Municipal □ Industrial D Agricultural D Monitoring □
Recovery D Heat Pump Water Injection □ Other D If Other, Lisi Use: ______________ _
2. WELL LOCA TIO · (Show a sketch of the location on back of form.)
Nearest Town:. _ _,1;u;_u.~~.L ________ Colinty _ __;b:.....:...A;...:J:..·n'---'o==-,,,,J"-"'-------
2 2 o S-,4.L,'l,{c,
(Road Name and Number, Community, Subdivision, Lot No.)
3.0WNER: f?;,.uLef OLIV(Je.
4. ADDRESS: d-~QS-ft:C-#te...._
5. TOPOGRAPHY: draw, slope, ~illtop, valle~
• · · 1 (c1rclc one) . ,.,
6. TOTAL DEPIB: / zy . DIAMETER._2-:;;._ __ _
7. CASING REMOVED:
fut ,.. I
· diameter
. 2.."
8. DISINFECTION: 1-1-tli / &.-,,P
(Amount of 70¾ hypochlorite used:)/
9. SEALING MATERIAL:
Ntat Cement
bags of cement / 2--
gal\ons of water S: Lf
Sand Cement
bags of cement'----
gallons of water __ ·
~ material 'J? C,--1 ~ cLe,r
Amount 2 S:: Be..; J?e---r
10. EXPLAIN ~OD a:!fLACEMENf OF MA~. . f9YfL ~ r _1__ tt1 Jl,l.fl-t.£ i40:vj
l l. DA TE WELL ABANDONED ---'Di..u..l .1..f..::::.'2.,=2.-:..s.!i..c:.0-=2.-==----t J,
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used. ·
' ~
'--I ~
~
~'-
,;:::.)
'-----1.. i ~
1aovNJ .Sfll hce..
f""' cJ...,.,-ott.. 2..,,
~\
~\ .... '{ ~ ~~
' " ('\
~
I do hereby certify that this well was abandon d in accordan e with
standards, and that a copy of the record has ee dedJo the well _ ' /_
0
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Signature of person abandoning the well ~' Date-!1FT2--
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 12/99
- - - - - - - - - - --·---111!!1 --

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f(,,. 7 I ~orth Carolina -Department of E~vironmcnt and Narural Resources -Division of\Vatcr Quality-Grqundwater Section -1636 Mail
Service Center-Raleigh, NC 27699-1639 -Phone No. [phone] ·
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\~LL ABANDONMENT RECORD WELLCO_NTRACTOR A/&-£~• . 7=-c::
WELL CONTRACTOR CERTIFICATION# 2-Z... L'S
1. ~LL USE (Check Applicable Box): Residential ~nicipal □ Industrial □ Agricul111ral □ Monitoring O
Recovery □ Heat Pump Water Injection □ Other D If Other, List Use:. ______________ _;,_
2. WELL LOCATION: Show a sketch or the location on back or form.)
NcarestTown: /. D.-v County (;!;,4-s,775,J I -..:=-:..:..:::..,....:;:_ ________ _
(Road Name and Number, Community, Subdivision , Lot No.) Quadrangle No.
3.0WNER: hKfl( (l.b&,!].J'J-A,F,r
. I .
4. ADDREss: lo 7 o bANt e L
5. TOPOGRAPHY: draw, slope, hilltop,~ flat
· · · · · ·, (circle one) 'i"
6. TOTAL DEPTH: Kf: . DIAMETER._?...--"·=----
7. CASING REMOVED:
fw '2-1
8. DISINFECTION: lffcl A< &--./
(Amount of70% hypochlorite used:) I
9. SEALING MATERIAL:
Neat Cement
bags of cement -J./..!:0:...__
gallons of water '7 0'
Sand Cement
bags of cement._ __
gallons of water __
-~:terial ., f: 1t: 7?~/-
10. EXPLAIN METIIOD EMPLACEMENT OF MATERIAL. P'"",e__ 7e----t: 7&/lf"'e pwvC
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and.diameter or
screens remaining in the well, gravel interval,
intervals or casing perforations, and depths and
~ or fill materials used. . ~ -r fv,r:¾_ f" 2.. I (¼ ro/-t. ---
1'
~ ~
11. DATEWELLABANDONED ~· 11/1£2--. . .
I do hereby certify that this weu ,Landoned in accordance with lSA NCAC 2C, well construction
standards, and that acopyofthe record ruiA~to the.:;ell o~cr'J'.1 "' • /. · · /
Signature of person abandoning the well ~ t{7. ~.e Date~2.._
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the ,direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 1 V99
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North Carolina. -Department of Environment and Natur3I Resources• Division of \Yater Quality -Gn~undwatcr Section -1636 Mail
Service Center -Raleigh, NC 27699-1639. Phone No. [phone] · ·
\VELL ABANDONMENT RECORD WELL CONTRACTOR /Hl"'M M.i ;;z;:_,,::._
WELL CONTRACTOR CERTIFICATION# 2-2-/ ,s-
I. WELL USE (Check Applicable Box): Residential ra/Municipal □ Industrial □ Agricultural □ Monitoring O
Recovery □ Heat Pump Water Injection □ Other □ If Other, List Use:. ______________ _
2. WELL LOCATION: (Show a sketch of the location on back of form.)
Nearest Town: 7lelm c,,.,-C ' County _ _,~~,f;!'.t.::..:..'-0-=:.--v'=.. _____ _
"2-z. 2 t A ct11 t'
(Road Name and Number, Community, Subdivision, Lot No.) Quadrangle No.
3. OWNER: 5-A.MAu,(}-L-
4. ADDRESS: .::l.:).";i / A ?ltfl?.
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5. TOPOGRAPHY: draw, slope, ~illtop, valley,~
· . ·· -(circle one) ''\7 1✓
6. TOTAL DEPTH: QS . DIAMETER._~2-__ _
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
7. CASING REMOVED:
fw
I
diameter
I/
8. DISINFECTION: t~r /I-f-2-e..,..,,p
(Amount of 70¾ hypochlorite used:) '
9. SEALINGMATERIAL:
Neat Cement
bags of cement S:--
gallons of water_..:;fJ;c,,:.O_
Qtbti:
Sand Cement
bags of cement ___ _
gallons of water __
Type material._-J./J..:..:oc..r-(_-"'----------
Amount ------------------
10. EXPLAIN METiiOD EMPLACEMENT OF MATERIAL. -rrz, (lf,U/ :(
11. DATEWELLABANDONED (JI;;~ I
...,
'-
~ ~ ~ ~
i ~
11/ ~ :)-., vJ!, ti
I do hereby certify that this well was aban ith I SA NCAC 2C, well construction
standards, and that a copy of the record has be n _ , /,, ,(,I'
Signature of person abandoning the well , . Date~
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised IV99
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North Carolina -Department o{ Environment and Natural Resources -Division of Water Quality-GrQundwater Section -1636 Mail
Service Center· Raleigh, NC 27699-1639 • Phone No. [phone] ·
\YELL ABANDONMENT RECORD WELL CONTRACTOR . IJ1 c{A // l{,,eo:; +:, c
WELL CONTRACTOR CERTIFICATION# ::Z Z I~
I. WELL USE (Check Applicable Box}: Residential ~unicipal □ Industrial O Agricultural O Monitoring □
Recovery O Heat Pump Water Injection □ Other.□ If Other, List Use: _____________ _
2. WELL LOCATION: Show a sketch of the location on back of fonn.}
Nearest Town: L o,,v r . County_-={;,ff:::'._,r:::.Z<:...~..,,z,"-',v'-=--------
,;t2-o7 t4.c__t11 e...
(Road Name and Number, Community, Subdivision, Lot No.) Quadrangle No.
3. OWNER: !1JJN:::....___Jh<.J<lc..!M..!!.::..,,,!£:::::..._ ____ IF===========
4. ADDRESS: d,),,_,D"-.7L_._,.A..!.....L./W...C.:.:.!:C.::._ ____ _
5. TOPOGRAPHY: dra_w&l§pp. hilltop, valley, flat
· . . . · , (circle one) 11 6. TOTAL DEPIB:._· / 2-(,,, . DIAMETER'-¢~--
7. CASING REMOVED:
fut ~, --
diameter
;)_ I,
8. DISINFECTION: Hr// Y7.-G'-'/J
(Amount of 70% hypochlorite used:) I
9. SEALING MATERIAL:
Neat Cement
bags of cement / 2-
gallons of water ff 1/
Sand Cement
bags of cement. __ _
gallons of water __
Othei:
Type material 7?e,...,f et, £JS
Amount z.s: 1? b 5 . r
10. EXPLAIN MEIBOD EMPLACEMENT OF MATERIAL. f t>Y L '.]?(',v ,r C l.., /}J SP :z s: I 'f' fl IMM ,i> 6i_t2D ..,T 1 'i9 !°'2-& 1
II: DATE WELL ABANDONED O I /2. 2... /c 2. r r
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used. · ·
-
112DLJN0 Sv/?Gf{('_
" (!,,vi " u 2-/
I do hereby certify that this well was abandoned in accordance with 15A NCAC 2C, well construction
standards,and_thatacopyoftherecordhasfl~tothewe~ ~, /..~ /
Signature of person abandoning the well ~ {'' ~Date~r,L
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2fnearby reference points such as roads, intersections and
streams. Identify roads with ~tale Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised I 2/99
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NOrth Carolina -Dcpactmcnt oC Environment and Narural Re.sources -Division of \Yater Quality -GrQundwatc:r Section -1636 Mail
Service Center-Raleigh, NC 27699-1639 -Phone No. [phone] ·
\VELL ABANDONMENT RECORD WELL CONTR,\CTOR It! e..&11 k,, k .
WELL CONTRACTOR CERTIFICATION# #-Z. 2../~
I. WELL USE (Check Applicable Box): Residential ~nidpal □ Industrial □ Agricultural □ Monitoring D
Recovery □ Heal Pump Water Injection □ Other □ If Other, List Use:. ______________ _
2. WELL LOCATION: (Show a sketch of the location on back of form.)
Nearest Town: ~~,v r County __,--=6."'v/5'-="-'D>'-'=~A/~------/0 C DJ. ~&,.,,e.Z::
(Road Name and Number, Community, Subdivision , Lot No.)
3. OWNER: Eol/J V C,g/,1,1/JSrA-IF I -. I .
4. ADDRESS: ID S--o Jm.t-11 e1...
5. TOPOGRAPHY~ slope, ~illtop, valley, flat · •• c::,:;:>_?S I (cm:le one) . 1 r
6. TOTALDEPTII: . DIAMETER.__..;)=----
7. CASING REMOVED:
fw d I
diameter
;2''
8. DISINFECTION: ftTfl Yz. ~
(Amount of70% hypochlorite used:)
9. SEALINGMATERIAL:
Neat Cement
bags of cement Y:
gallons of water 2-8
Olhcr
Saad Cement
bags of cement. __ _
gallons of water __
Type material. _____________ _
Amount. ________________ _
10. EXPLAIN METIIOD EMPLACEMENT OF MATERIAL.
-pz / 11 Aile f-4"" '-
11. DATE WELL ABANDONED_· -"'t)'--'/~).L...:.(;:...,,Z<--o c_z... __
J I
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
weil showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
' I . F )-iµ)f
I do hereby certify that this well was abandoned · accordanc with !SA NCAC 2C, well construction
standards, and that a copy of the record has b n a to the well "
1
/,. /
Signature ofpers·on abandoning the well (_ Date~D '2.-
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the direction and distance
of the well to at least two (2i nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 12/99
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N:orth Cua Jina -Department o( Environment and Nanual Resources -Division of \Yat~r Quality -Grqundwater Section -1636 Mai1
Service Center-Raleigh, NC 27699-1639 -Phone No. [phone] ·
'\YELL ABANDONMENT ~CORD WELL CONTRACTOR iJ1e G;4-// ;?A>, ~
WELL CONTRACTOR CERTIFICATION # 2-Z../ C
1. WELL USE (Check Applicable Box): Residential r:i/Municipal □ Industrial O Agriculrural O Monitoring O
Recovery □ Heat Pump Water Injection O Other □ If Other, List Use: ______________ _
2. WELL LOCATION: (Show a sketch of the location on back of form.)
NcarestTown: ·. J;eft,,,0 ,-,r · County __ tJ_"'1-_,_n,_._,.,; ______ _
,2 ;'.6 ,,'.2 c\:: A-C (1-t -t'.--.
(Road Name and Number, Community, Subdivision, Lot No.)
3. OWNER: :Je<U: L-¼uLH
..
4. ADDRESS:._....c.J"'-"":7""..1.""9'--_,_/--'--=fc..::.,:M.:., . ..,,(_,~----
5. TOPOGRAPHY: draw, slope, hilltop, valley@
· 11 1 (circle one) C-// •
6. TOTAL DEPTH: / ?I ·. DIAMETER J G,4L/.
7. CASING REMOVED:
kc!
I
diameter ,<:;''
8. DISINFECTION: V Ttf-{ (}e,,f)
(Amount of 70% hypochlorite used1
9. SEALfNGMATERIAL:
Neat Cement
bags of cement __,/-=Z-=--
gallons ofwatcr._~a...:,'f'---
Sand Cement
bags of cement. __ _
gallons of water __
~ material 1e/VJo_ L k
Amount 3'P J?lS,5,
10. EXPLAIN METilOD EMPLACEMENf OF MATERIAL. ea w·?-1?e"' h~ ti< :C??t Mt':1d: qde-C
11. DATE WELL ABANDONED __ D__,{...J;l.L.Lr...J;lc'-"o'-'~="'---r 1
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
. well showing total depth, depth and diameter of
screens remaining in the. well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
y ~ 1,
-~~ ,., ,-
~ 1.-'-
'-"'< -~
~ C'1 ~ \ "'-
~,-~ ~ ~ ~
'-~ i ....
Iv) ~ ....._.
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the ,direction and distance
of the well to at least two (2jnearby reference points such as roads, inlersections and
streams. Identify roads with State Highway ro.ad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised IV99
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North Cirolina • Department of Environment and Nanm:il Resources -Division of \Yater Quality• GrQundwatcr Section• 1636 Mail
Service Center• RAieigh, NC 27699-1639. Phone No. [phone] ·
\YELL ABANDONMENT RECORD WELL CONTRACTOR )11t1t/4:// MJ ,6-c..
. . . WELL CONTRACTOR CERTIFICA'f!ON # __ 2--_2f:~>~· ___ _
I. WELL USE (Check Applicable Box): Residential ifMunicipal D Industrial □ Agricultural D Monitoring O
Recovery D Heal Pump Water bijection D Other D If Other, List Use: _____________ _
2. _WELL LOCATIO~Show a ske:':9f the location on back of form.)
Nearest Town: fidM o ~c_ County _,,,6."-'A-'-S:-'.a>-,,,.J....c......::.._ ______ _
/l2..';JS-&CM'{ .
(Road Name and Number, Community, Subdivision , Lot No.)
3.oWNER: ·~eU ~:i!J u+
4. ADDRESS: -J.).d-8 A-LMC:...
5. TOPOGRAPHY : draw, slope, ~illtop, valley~ · I, I {etrcleone) I/
6. TOTALDEP TH:,1 S: . DIAMETER .;2 f
7. C_ASING REM
2
OVED:
fw
I
ON: 11-rL-f
diameter
':)..'/''
I 6v p 8. DISINFECT!
(Amount of 70% hypochlorite used:} • '
9. SEALING MA
Neat Cc
bags of
gallons
TERIAL:
mcnt
cement )5"
ofwater /]r
Sand Cement
bags of cement
gallons of water __
QthcJ:
aterial Typem
Amount
joo1' b.s 1:' ~-1-&-J L b e!,
I
I 0. EXPLAlN M
povf;-
ct::: EMPLACEMENT OF MATERIAL. .s Irti !'.!1 M!!'. · &M. e~r
11. DATE WELL ABANDONED 0/ t::.~/2 L--. r I
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
IJ-Me/V'l--P
C:, v t:;' • e,,.,,~
q -.. ,i ~ ~ tr/--
1 & !5
<
~ · d' f I fj o,<_{ l, le.
I do hereby certify that this well was abandoned in accordance with I SA NCAC 2C, well construction
standards: and that a copy of the record has b~e~ro~ded ~o ~
Signatureofpersonabandoningthewdl {1£,{;;(. ~ Date t:J1k/2z..._ J l
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway re.ad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment;
GW-30 Revised I 2/99
l,UOOOLA-W?J
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North Cuolina -Department of Environmcnc and Narural Resources· Division of\Vatcr Quality• Grqundwaccr Section• 1636 Mail
Service Center-Raleigh, NC 27699-1639. Phone No. [phone] ·
'\VELL ABANDONMENT RECORD wELL coNJ1tA.croR /f1efA/( AfbJ he_
· · · · WELL CONTRACTOR CERTIFICATION, 2-Z-1 C
I. WELL USE (Check Applicable Box): Residential ;;;:;:;unicipal □ Industrial □ Agricultural □ Monitoring O
Recovery D Heat Pump Water Injection □ Other □ If Other, List Use: ______________ _
2. WELL LOCATION: (Shpw a sketch of the location on back offonn.)
Nearest Town: '1ft'//111?Hf: County __,11,=<..:..,45.!..'.:....:...Ti..=2'.;,.N.::..... __ ~---
~ ~) J AcMf .
(Road Name and Number, Community, Subdivision, Lot No.) Quadrangle No;
3. OWNER:.__,_,D~-S'-l-"~"--'-A-(2o,J:.....c...._-----l,LW=.. . ....:....A{l~/(_=---w========
4. ADDRESS: . .J. a_ .2, 3
5. T<JPO;RAPHY: draw, slope, ~illtop, valley'®)
· . · (can:le one) //
6. TOTAL DEPTH: . /;5 'f . DIAMETER.~,2~--
7. CASING REMOVED:
fw
:).,
diameter
:) II
8. DISINFECTION: /frlf fz_. ~f' ' (Amount of 70% hypochlorite used:)
9. SEALING MATERIAL:
~at Cement
bags of cement _n'.,._ __
gallons of water /,? '/
Otbu
Sand Cement
bags of cement. __ _
gallons of water __
Type material. ______________ _
Amount. ________________ _
10. EXPLAIN METIIOD EMPbACEMENT OF MATERIAL
TIZ IM/111 f:-. ftZt.9vr
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
.......
\
L,
i\
~-' \'-~"' ~~
<;:i
tj~ DvN £ s V ;[' t'+c,r
'f.tu r (9,~ z/
ll
I l. DATE WELL ABANDONED f) 7/rr)'-z__ .
I do hereby certify that this well was abandoned in accordance with 15A NCAC 2C, well construction ·
s~ndards, and that a copy of.the record has ~ce~ed t~ ~~ ·
S1gnaturcofpersonabandomngthewellc~ ( ~ , Datc#L
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2fnearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment. ·
GW-30 Revis~d t 2J99
-------------------
North Carolina -Department of Environment and Natural Rc:sOurc:cs -Division of \Vaccr Quality -Groundwater Section -16)6 Mail
Service Center -Raleigh, NC 27699-1639 • Phone No. [phone] ·
D \VELL ABANDONMENT RECORD WELL CONTRACTOR /Jtu,(-// J?:ttJ5 £;_,c_
. . ' WELL CONTRACTOR CERTIFICATION # z. z IS
m I. WELL USE (Chee!:: Applicable Bol<): Residential efMunicipal □ Industrial □ Agricultural □ Monitoring O
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Recovery □ Heat Pump Water Injection □ Other □ If Other, List Use: ______________ _
2. WELL LOCATION: (Show a sketch of the location on back of form.)
Nearest Town: ?/;rt ON r County -=b=A--'-"-..5-'/1.--'Zl,a...:..N.:;_ ____ _ ~..J..3'2-~ .. -e__.
(Road Name and Number, Community, Subdivision , Lot No.)
3. OWNER: Q, f2eq o/2-*
4. ADDRESS: ~ ;? 3 d.. ·
Cc a£,
Ac.;n!Z
5. TOPOGRAPHY: draw, slope, hilltop, valley,~ • J . /(circle one) t,
6. TOT AL DEPTII: /)0 DIAMETER._,._{p""--
7. CASING REMOVED:
fu..t :J_ I
diameter
l,,FI
8. DISINFECTION: J-1. 7 If fz e.ve
(Amount of 70% hypochlorite used:) I
9. SEALING MATERIAL:
Neat Cement
bags of cement _,8'"---
gallons of water :( le ·
Sand Cement
bags of cement. __ _
gallons of water __
~ material -Ce~n,~, k:
Amount ;). S ft (q.)
10. EXPLAIN METijOD E¥PLACEMENT OF MA. 1:lRlAL. .. ..
12.D..u@ 7J ,.N /o/Vf k . . ,-,--'
ljd,111u1e 140,._,c e-Me,,,,( . -
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used. (
C,(c'"""D 5\J,t~u{'._
•
11. DATE WELL ABANDONED __:{)--'I /Jc.<./_,._t/,.,_,,i,....v_· -'-·-_·-_· Ii============= r 7
I do hereby certify that this weU was abandoned in accordance with 15A NCAC 2C, well conslruction
standa~ds, and that a copy of the record has b~n ~'1Jd to th~ well ➔er. / J .
Signatureofpersonabandoningthewell &~ { J~ Date I ½ 0 L-
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2) .!learby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner wi1hin 30 days
from completion of abandonment.
GW-30 Revised I 2/99
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North Caro Jina • Department o( Environment and N.3.rural Resources · Division of \Yater Quality -Grqundwater Section -1636 Mail
Service Center-Raleigh, NC 27699-1639 -Phone No. [phone] ·
\VEL:l, ABANDONMENT RECORD WELL CONTRACTOR IJ1etit-t/ · ,2?µ_, £ <::...
wELL coNTRACToR cERTIF1cAr10N • 2..2-r,-
I. WELL USE (Check Applicable Box): Residential ~nicipal □ Industrial □ Agricultural □ Monitoring □
Recovery □ Heal Pump Water Injection □ Other □ If Other, Lisi Use:·-----~--------
(Road Name and Number, Community, Subdivision, Lot No.) Quadrangle No.
3. OWNER: T/lt?MA j f!._,4 b LIZ-
. I . .
4. ADDRESS: II<:'· Q DA-tv1'(,I •
5. TOPOGRAPHY: draw, slope~alley, flat
. . I~) //
6. TOTAL DEPTII: g-:S . DIAMETER __ 2 __ _
7. CASING REMOVED:
fut
k-I
diameter
2-''
8. DISINFECTION: Hrt+ ,&. e....-.,,o
(Amount of70¾ hypochlorite used:) /
9. SEALINGMATERIAL:
Neat Cement
bags of cement / 0
gallons of water 'JO
Sand Cement
bags of cement __ _
gallons of water __
Other .
Typematerial lk~>-,k e/!.✓J
Amount IQ 72<1;:.s
10. EXPLAIN METHOD EMPLACEMENT OF MATERIAL.
<Jo, ,(2 1?1?~1 k µt(&t!fl/7 f-A r r·
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED IJ ( Z..1,;z 7..-f~ .
I do hereby certify that this well was abandoned in accordance with I SA NCAC 2C, well construction
standar-ds, and that a copy of the record ha:~!~ to the well o~. // / _ /."' /
Signatureofpersonabandoningthewell ~ e ~ Date~~L
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2)"nearby reference points such as roads, intersections and
streams. Identify roads with State Highway re.ad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised !V99
DLA-t-v.iv r.,voo
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Nor1h Carolina• Department of Environmcnc and Na.rural Resour'ces -Division of Wat~r Quality -Grqundwatcr Section -1636 Mail Service Centcr-lWeigh, NC 27699-1639. Phone No. (919) 7JJ-J221 ·
\VELL ABANDONMENT RECORD wELL coNTRACToR 1/1 e /},.;( ~, £-"-.
' ; WELL CONTRACTOR CERTIFICATION# P z_ 2-I r"
I. WELL USE (Check Applicable Box): Residential ~nicipal □ Industrial O Agricultural O Monitoring O Recovery O Hea_t Pump Water Injection □ Other O If Other, List Use:. __________ _:_ __ _
2. WELL LOCATION: (Show a s~:h of the location on baclc of form.)
Nearest Town: • $Pt ,1!1..()A/ r County --=6-'-A.-'-"--:r-"-y...Cz,_,J ______ _ tit/ Q1)A,v1 ~ t .
(Road Name and Number, Community, Subdivision, Lot No.)
3. OWNER: f/ffLLI 5 St:11 rtf
4. ADDRESS:_/,,.,._1/_,_i/_· ---"'D_1_1,t;;..<◊.<..td.:.cN:;.,/c.::c~...;;:L;;c__ __ _
5. TOPOGRAPHY: draw, slope, hilltop, valley@
• · 1 I (cin:le one) ? ll 6. TOTAL DEPm: IO--c · · · DIAMETER.~..,_;L __ _
7. CASING REMOVED:
fw d I
diameter )"I I
8. DISINFECTION:· ffr/1-~ (!.,...,£)
(Amountof70% hypochlorite us~) V
9. SEALING MATERIAL:
Neat Cement Sand Cement
bags of cement~ bags of cement
gallons ofwatcr--11:!f--gallons of water __
~material 8e,vf et-/J.f
Amount 10 RqJ 1
I 0. EXPLAIN METiiOD EMPLACEMENT OF MATERIAL. f 0va. Fe.vb-, le VtrM/11-e fjk=-r•
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
I I. DATE WELL ABANDONED t2 /~Z: . .
I do hereby certify that this well was abandoned in accordance wi 1 SA NCAC 2C, well constructton
standards, and that a copy of the record has been p 'd o '~ well own r.
Signature of person abandoning the well_b,-~=~~...!{'=-.:-·_£:.-:::J.~~::::'.l:_ __ D1ate o)'~/o L-
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the .dir~tion and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW -30 Revised I 2/99
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Ncrth Carolina -Department of Environment a.nd Na.rural Resources-Division of\Vatcr Qualiry-Grqundwater Section -1636 Mail
Service Center• Raleigh, NC 27699-1639. Phone No. [phone] · ·
'\VELL ,'IBANDONMENT RECORD WELL CONTRACTOR 4t G..f'A-t( %@; h
. . WELL CONTRACTOR cE.tfrinCA TION # z;z_ ' s-
I. WELL USE (Check Applicable Box): Residential ~nicipal □ Industrial □ Agricultural □ Monitoring D
Recovery □ Heal Pump Waler Injection □ Other D If Other, List Use: _____________ _
2. WELL LOCATION: (Show a sketch of the location on back of form.)
Nearest Town: . P/&,,,_ C . County _..._&""-::,:A.,.,'-5::...&'-'=aw=. _____ _
'f/'f jJ VMpNr' .
(Road Name and Number, Community, Subdivision, Lot No.)
3.0WNER: /< lj-t M(l,(!tV S;I/J6XA-V l I .
4. ADDRESS: L//lf J)u&~Al:I
5. 1:"0POGRAPHY: dra~ hilltop, valley, flat • · · ? l {circle one) /. //
6. TOTAL DEPTH: 2',JO .. DIAMETER._'-" __ _
7. CASING REMOVED:
fw %)-I
di3metcr
·f,,, f(
8. DISINFECTION: ftz:fl: / <!...u.f-
(Amount of 70% hypochlorite used:)
9. SEALING MATERIAL:
Neat Cement
bags of cement I 2....
gallons of water li--1/
Sand Cement
bags of cement, __ _
gallons of water __
~ materia'.:..I_'1i.ec.:e.ae;1.,.;:,,..f _________ _
Amount fa 7? G. ~
10. EXPLAIN METiiOD EMPLACEMENT OF MATERIAL. pcv tZ-£.e,.,;{,,t-, (e "fitt tYM-1£._ fP uC .
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used. O
. . 4'/tO""~ )IJr2µ
11. DATE WEI.I. ABANDONED O { I f;/4 2-
I do hereby certify that this well ~ abandon~d in accorda NCAC 2C, well construction
standards, and that a copy of the record has be ll vi to • ,, /, /_
Signature of person abandoning the "'.'ell Date~ "2...-
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2)°nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section,_one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised (2/99
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North Carolina .. Department of ~vironmcnt and Natural Resources -Division of \Yater Quality .. GrQt.mdwater Section -1636 Mail
Service Center -Raleigh, NC 27699-1639. Phone No. [phone]
\YELL ABANDONMENT RECORD ~ELL CONTRACTOR 111 e & 11· @:::, h,c_
WELL CONTRACTOR CERTmCATION # 2, 2./ , . -
I. WELL USE (Check Applicable Box): Residential ~nicipal □ lndustria_l O Agriculrural □ Monitoring O
Recovery O Heat Pump Water Irijcction D Other O If Other, Lisi Use: __ ·--------'-------
2. WELL LOCA TIO~Show a sketch of the location on back of fonn.)
NcarcstTown: ""ff._elmwf: . County_..,.llc..c-1_...'5.._.._71-'=D'-'/V ______ _
220~~
(Road Name and u'inber, Communi;, Subdivisio1• Lot No.) Quadrangle No.
3.oWNER: :;)eki0 ~£, (1, '1-i1
4. ADDRESS: .:).;)./)7 lf?/11/£.
5. TOPOGRAPHY: draw, slope, hilltop, vallcy_g)
· · · (circle one)
at
6. TOTALDEPTII: ~~ . DIAMETER
7. CASING REMOVED:
.fi:ct rliametc r I ,
8. DISINFECTION: l+rff /:z
(Amount of 70% hypochlorite used:)
9. SEALINGMATERIAL:
,,
~ ~
I
2.., ll-
Nca t Cemcn t Sand Cc
bags of
. gallons
mcnt
bags of cement .....,.,J,..__
gallons of water J. f
Olha:
Type material._.:./v.c....:c().:.../t,{'-==-----Amount. __________ _
cement
ofwatcr ___
10. EXPLAIN METIIOD EMPLACEMENT 0 FMATERIAL.
Trlt f'-<c-t c
'
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval, .
intervals of casing perforations, and depths and
types of fill materials used. .
.
-
·d,vf oC.-v v1 ~
\.,_ 1{l°"' ~t
), )
I\) t
' 111 ;
J ~ J .. ~ ~
i'I. DATE WELL ABANDONED (?I !ty/g 'l....-
/ 1 .
I do hereby certify that this well was abandoned in accordance with !SA NCAC 2C, well construction
standards, and that a copy of the record has been"! to thew:=~ /7/7
Signature of person abandoning the well e~ L ~ Date._c~::'.· :t-+,-,q.~
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonmenL ·
GW-30 Revised t 2199
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North Carolina -Department of Environment and Narura! Resources -Division of ,vatcr Quality -Grqundwatcr Section -1636 Mail
Service Center• Raleigh, NC 27699-1639 -Phone No. [phone] ·
\VELLABANDONMENTRECORD . . .
. . ?
WELL CONTRACTOR-,,.111:..Lb __,____e. ...... {;4-~,__6,....1/---.&"'°"" ... ,,,""'J=--" -k=-=~<--:
WELL CONTRACTOR CERTIFICATION# _=2-~2..~/-S::::~---
I. WELL USE (Check Applicable Box}: Residential ~nicipal □ Industrial O Agricultural □ Monitoring D
Recovery O Heal Pump Water.Injection □ Other □ If Other, List Use: ______________ _
2. WELL LOCA TIO~~ow a sketch of the location on back of form.}
Nearest Town: .,f5r' /mOA/ r County _t:,4._·-'-"c_s:c...c.n:;..=c..:.A}-=--,------.....,..-
2. z 2..1 d:C/C!,:
(Road Name and Number, Community, Subdivision , Lot No,)
3. OWNER:'. s A M. U A-L
4. ADDRESS:---'~:.....·-~_-:)..__,_/ _L-.flc...:C._,__/11'--'-. =£:;.___ __ _
5. TOPOGRAPHY: draw, slope, hilltop, valley(iiat)
· . · • · . I (circle one) , ,
6. TOTAL DEPTII: // 7 . DIAMETER_ . ..,sS,,__ __
7. CASING REMOVED:
kd
sa2
· diameter s''
8. DISINFECTION: /-I Tlf f;__ e,...,,_,,:?
(Amount of 70% hypochlorite used:) r
9. SEALING MATERIAL:
Neat Cement
bags of cement :J---=,...,...-gallons of water Sip
Sand Cement
bags .of cement. __ _
gallons of water __
Qther ,,, / ,, Type material 7.?e,-.,,/o,v, k ~
Amount .;J S: '7?,:;; 5 .
10. EXPLAIN METIIOD EMPLACEMENT OF MATERIAL.
r2w12 Z?e~ro..u-1 t<-7",e,,-we1-1c-1,4fvr /
. 11. DATE WELL ABANDONED __,.Q~l+IL.-'-+:(1,_~~0_Z.... __ ~ 7 1-f-
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fillinatc:rials used.
./
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2)'nearby reference points such as roads, intersections and
streams. Identify roads with State Highway re.ad identification numbers.
Submit original to the Division of Waler Quality, Groundwater Section, one copy to the owner wi1hin 30 days
from completion of abandonment.
GW-30 Revised I 2/99
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North Carolina-Department of Environmcn~ and Na.rural Resources -Division of Water Quality-GrQt.mdwater Section -1636 Mail
Service Center• Raleigh, NC 27699-1639. Phone No. [phone] ·
\YELL ABA,NDONMENT RECORD WELL CONTRACTOR. Y\11. e..f!,,o,.,1 I. Jib' ;:t;ic...
WELL CONTRACTOR CERTIFICA "J"ION # 2.. -Z-l :i
I. WELL USE (Check Applicable Box): Residential ~nicipal □ Industrial 0 Agricultural □ Monitoring O
Recovery O Heat Pump Water Irijection D Other O lfOther, List Use: ______________ _
2. WELL LOCATI~ (Show a sketch of the location on baclc offonn.)
Nearest Town: T ~el,'W>v:r: . County {1,,t,.srt>.u
I Z 2.. 0 :S f\-C{".lf --=--'--------
(Road Name and Number, Community, Subdivision , Lot No.) Quadrangle No.
I" 3. OWNER: f<o be.~T S P':lT~
4. ADDRESS: ~:;;>.63 AC./VI-C,. • WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and I
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5. TOPOGRAPHY: draw, slope, ~illtop, valley~ ·
. · 1 {carclc one) · 1,
6. TOTALDEPTII: ) 41-. DIAMETER'--'3"'". __ _
7 .. CASING REMOVED:
fi:c.t
2-'
diameter >"
8. DISINFECTION: tf-TJ+ I c..~
(Amount of70% hypochlorite used:
9. SEALINGMATERIAL:
Neat Ceinent
bags of cement 12.
gallons of water 8 r Sand Cement
bags of cement. __ _
gallons of water __
~ material._?~·::...:..t:L--->eb~4 f_J __ _
Amount is:: 4s
I 0. EXPLAIN METIIOD EMPLACEMENT OF MATERIAL. fouf? CL,r~ lP vo'
1 I. DATE WELL ABANDONED t> I /2:Lle "L,:. r l
types of fill materials used'. . /)
. ,._,,.J._ S "f2..V--A c,{
I do hereby certify that this well was abandoned ·n accordance "th ISA NCAC 2C, well construction
standards, and that a copy of the record has been o · d lo the well o _ , / ~ /
Signature of person abandoning the well (, Date~ 2....
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit originafto the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised IV99
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North Carolina. Department of Environment and Na.rural Resources -Division of \Vat er Quality • Grqundwater Section -: I 636 Mail
Service Center• Raleigh, NC 27699-1639. Phone No. [phone] ·
,VELI,, ABANDONMENT RECORD WELL CONTRACTOR /11._eC+I/ J?,u _; :;£:~
WELL CONTRACTOR CERTIFICATION# 2.2. /J-
I. WELL USE (Check Applicable Box): Residential ~unicipal D Industrial 0 Agricultural □ Monitoring D
Recovery O Heat Pump Water Injection O Other D If Other, List Use: ______________ _
2. WELL LOCATION: (Show a sketch of the location on baclc of form.) ,ti _
Nearest Town: ::Ee ( M o--iT County ~&:rlc~ci..=s__,_z:-o...c.._..,J _______ _
I{) 2.-o r l)t4-'i e,
(R~ad Name and Number, Community, Subdivision , Lot No.) Quadrangle No.
3. OWNER: b A:use L /vlfh2.L Dw e_
. . I
4. ADDREss: I D 2-D DM ,e L
5. TOPOGRAPHY: draw¼0hilltop, valley, flat
. · · 1 -(circle one) . ;1 6. TOTAL DEPTII: /7'/-. DIAMETER'--'.5c.....-__
7. CASING REMOVED:
fw
~I
diameter ,,
8. DISINFECTION: l e_.v P H-TJ-f-
(Amount of 70% hypochlo~te used:)
9. SEALINGMATERIAL:
Neat Cement
bags of cement
gallons of water
Sand Cement
bags of cement. __ _
· gallons of water __
~ material 'l?e-~ cJ~f;
Amount ?o ll {pJ 7?e~t:: C hf '
10. -EXPLAIN ~ETHOD EMPLACEMENT OF MATERIAL. pcurz__ Mi/' MM.Ye r4 vC
11. DATE WELL ABANDONED f)/ !2-2., lo?..--.
'/ I
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals o_f casing perforations, and depths and
types of fill materials used. · J t· -
_ 'f,flPv" rut 't«'
'-
~
<:. I
\),... ~
t'\) \...._
" "' ~ ·--.. ' ~ C\)
I'-
I do hereby certify that this well, CAC 2C, well construction
standards, and that a copy of the record -=-_ . / /
Signature of person abandoning the well+-,,,C:::.=~"-"...:Ll....t::...=......l:52.k6. ____ Date~
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
· GW-30 Revised 12/99
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North Carolina• Department of Environment and Na.nual Rc:sourcc:s · Division of \Va.ter Quality. Grqundwater Section• 1636 Mail
Sc,vice Center-Raleigh, NC 27699-1639 -Phone No. [phone] . ·
\VELLABANDONMENTRECORD WELL CONTRACTOR ,lk{e: ~I 4µ7-1 ...).,-..,-c.
WELL CONTRACTOR CERTIFICA1"10N # _ _.2-=Z--~l_.,,C ___ _
I. WELL USE (Check Applicable Box): Residential ~unicipal □ Industrial □ Agricultural □ Monitoring O
Recoveiy. □ Heat Pump Water Iiijection □ Other □ If Other, List Use: _____________ _
(Road Name and Number, Community, Subdivision , Lot No.)
3. OWNER: \ ef)rJA,tJ t'--Dbb
.4. ADDRESS:\2 2.. ✓-~ Acmg
5. TOPOGRAPHY: draw, slope, hilltop, valley,@JV
• · · (circle one) , /
6. TOTAL DEPTH: /I S, . . DIAMETER._· ,:::c}.,'----'--'-
7. CASING REMOVED:
.fret
;)'
diameter
2/f
8. DISINFECTION: H Ttf · / <!..-,.....,/2
{Amount of70% hypochlorite used:}
9. SEALING MATERIAL:
Neat Cement
bags of cement _J:;:::,,_
gallons of water-5c+--
Sand Cement
bags of cement. __ _
gallons of water __
Other -('
Type materia!._'J?_.:::e_,,__.,;;__t-..,__.......::,Cl,;;,=-::··--=-Fp'---.s ___ ~
Amount \D :V 1 J
I 0. EXPLAIN METHOD EMPLACEMENT OF MATERIAL. F(Z.. cL,rn ::f/?IM.M,tf 'itZcvC
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining In the well, gravel interval,
intervals of casing perforations, and depths and
types of fill ma.terials used. /I f
. . t-h1frvrVdc. Svll ~
C I,
WELL LOCATION: Draw a location sketch on the: reverse of this sheet, showing the.direction and distance
of the well to 'at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 12/99
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North Carolina -Department of Environment and Natural Resources -Division of \Yater Quality -Grqundwatcr Section -1636 Mail
Service Center-Raleigh, NC 27699-1639 -Phone No. [phone] ·
'\VELL ABANDONMENT RECORD .. WELL CONTRACTOR m ew/ 17-,· ~
. . WELL CONTRACTOR C RTIFICA 'flON # :Z ~ S-
I. WELL USE (Check Applicable Box): Residential ~nicipal □ Industrial □ Agricultural □ Monitoring D
Recovery D Heat Pump Water Injection □ Other D If Other, List Use: ______________ _
2. WELL LOCATION: (Show a s,etch of the location on back of form.)
Nearest Town: ~i'[JJt.o ~ C Counly _t(;F''.:./4"-"''--Lrp~tt/-=-------. "'2-'Z---'2-0 . A-ct<! e.
(Road Name and Number, Communily, Subdivision, Lot No,)
3. OWNER: M : ~{Co t.<-> Af
4. ADDRESS: ef;) ;;i.o 61 c...µe_.
5. TOPOGRAPHY: draw, slope, hilltop, vane&
· · f (circle one) / 1
6. TOTAL DEPIB: / Lff . DIAMETER._,,,d:__ __
7. CASING REMOVED:
fw
2'
diameter
:;, "
8. DISINFECTION: I± T tf fr
(Amount of 70% hypochlorite used:
9. SEALING MATERIAL:
Neat Cement Sand Cement
bags of cement I z_,. _bags of cement._ __
gallons of water ff3/ gallons of water __
~ material §e...,-/-e/t r
Amount I D 'll G: I •
IO~Lf ~ETIIOD EMPLACEMENT OF MATERIAL. ~ {),.(_,f +o S°5--1 tft/1••'-II•<-,('._ ·
11. DATE WELL ABANDONED _l9=..:..l1-l...:'2-::__2--_,_/4-=-o_, i-__ _ r1
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
I do hereby certify that this well w accordance
1
\bfcr,,'/ CAC 2C, well construction .
standards, and that a copy of the record ha • , /.. , f
Signature of person abandoning the well Date~ 2--
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2)nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 1V99
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North Carolina -Department of Environment and Narural Resources -Division of \Valer Quality -Grqundwatcr Section ~ 1636 Mail
· Service Center• Raleigh, NC 27699-1639. Pbone No. [phone] · ·
'\YELL ABANDONMENT RECORD WELL CONTRACTOR met;--.// µ{)J .:7:,c..
WELL CONTRACTOR CERTIFICATION # ;!... 2.. L C:
1. WELL USE (Check Applicable 13ox): ResidentialZunicipal □ Industrial □ Agricultural D Monitoring □
Recovery O Heat Pump Water Injection □ Other □ If Other, List Use:. ______________ _
(Road Name and Number, Community, Subdivision , Lot No.)
3. OWNER: °DA-IZ&e;LL j2l L:et' 7
4. ADDRESS:,___:2-__;:2--:;..·_,,C.....:::.2...'--.LA...L.:=CM-e:~~-~----
5. TOPOGRAPHY: draw, slope, hilltop, valley.!!!ii2
. . · { (ci~le one) L " 6. TOTAL DEPTII: / 2 2-. · DIAMETER'----"2... __ _
7. CASING REMOVED:
fi:ct '2.. r diameter cl
s.' DISINFECTION: t-J.-rf/-Y2 L-'-'f.-
(Amount of 70% hypochlorite used:)
9. SEALINGMATERlAL:
Neat Cement
bags of cement L 2-
gallons of water :f 3/
Sand Cement
bags of cement. __ _
gallons of water __
~material ~~-d.or
Amount \'!) 1? l ,s-1
10. EXPLAIN tr{ETIIOD EMPLACEMENT OF MATERIAL.
{)D11@-c,u..,f! TIZ,;1-{/11/( p~u.C
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
qaour-JJ 511gf:fr?€.
\::_ C-,v-r o--t.-l-2--I
~
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2rnearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised 12/99
~
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North Car01ina • Dcpartfficnt or Environment and Narural Resources· Division of,Vatcr Qualiry-GrQundwatcr Section• 1636 Mail
Service Center• Raleigh, NC 27699-1639. Phone No .• [phone] ·
\VELi ABAM)ONMENT RECORP WELL CONTRACTOR__cM_-=...c_(;-=,4---;--'-'<-f,,_/_~c.72;.:::;~:::c........1 _ _.7;:~:...<!.=..__
WELL CONTRACTOR CERTIFICATION# _.=2--=Z--'-""-/'-',c'--· __ _
1. WELL USE (Check Applicable Box): Residential Municipal O Industrial O Agricultural D Monitoring D
Recovery D Heat Pump Water Injection D Other D If Other, List Use: _____________ _
2. WELL LOCATION: (Show a sketch of the location on back of form.)
Nearest,Town: J':e{M.,......,., . . County _ __,~,,_-ec.;.:..A:.:cS_v,.:._;:,_.,_j _____ _
(Road N~f;;i~u!;,"co~unity, Subdivision, Lot No.) . Quadrangle No.
3.0WNER: ~UJ('w &bb<>ft?L,/4=. ========
. 4. ADDRESS: ;)_,;;]'_] 'f A-Cfi.le
5. TOPOGRAPHY: draw, slope, hilltop, valley,cfiiC?
. · · · ( (circle one) . ff
. 6. TOTALDEPTII: \].¥ . DIAMETER.--='5 __ _
7. CASING REMOVED:
fw
2-''
diameter z_..<f
s. DISINFECTION: ttn+ 1 e.,...,~
(Amount of70% hypochlorite used:)
9. SEALING MATE~:
Neat Cement
bags of cement ___,!e....:'L::....,.._
gallons of water r;y
Sand Cement
bags of cement. __ _
gallons of water __
~ material :J?e,...f--Cbf S
Amount 2b -(? JS
1 O. EXPLAIN :,.1ETIIgpEMPL~MENr OF MATERIAL. ~* C l,....f -1:Q ~ I 1]Lt,,..,... ' C
1 I. DA TE WELL ABANDONED QI / ?,,7.,,/6 2--. I I
I do hereby certify that this well was ab
standards, and that a copy of the record has bee
WELL DIAGRAM: Draw a detailed sketch of the
well showing total depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used . q tZouN-0 . ~l;,a C;_,,._c,e_
~ C-<,, r c) C.L
\'--. 2-'
CAC 2C, well construction
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _directio and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.·
GW-30 Revised 12/99
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North Carolin.i -Department of Environment and Natural Resources· Division of Water Quality -Grqundwatc:r Section -1636 Mail Service Center• Raleigh, NC 27699-1639. Phone No. [phone] . -,--
'\YELL ABANDONMENT RECORD WELL CONTRACTOR &&II .M<? J --k::c..
. . WELL CONTRACTOR CERTIFICA '!"ION # Z.Z-IS:
/
I. WELL USE (Check Applicable Box): Residential ~unicipal □ Industrial □ Agricultural □ Monitoring 0 Recovery □ Heat Pump Water Injection D Other □ If Other, List Use: _____________ _
2; WELL LOCATIO~Sh9w a sketch of the location on back of form.)
Nearest Town: p.t:>//U¥(T: County G,Ar,ro,,,./ dQ f CRtJTT'tf VI e.Jd --=:...:._:_ ______ _
(Road Name and Number, Community, Subdivision , Lot No.)
3.0WNER: PA--r.€/Ct-A Y&Li;-~ I
4. ADDRESS: J...61 f'__p,v /e.(".u1ew
5. TOPOGRAPHY: draw, slope, hilltop, valley,~ · · · · -J (circle one) ;r 6. TOTAL DEPTH: / J 2;. . DIAMETER S ✓ . -~~--~
7. CASING REMOVED:
fi:ct
:Z'
diameter·
{f
8. DISINFECTION: tf '[lf / (],.<..,,P
(Amount of 70% hypochlorite used:) '
9. SEALINGMATERIAL:
Neat Cement ·
bags of cement / 2--
gallons of water G:'(
Sand Cement
bags of cement. __ _
gallons of water __
~ material $e,~ f tJ.ff r
Amount /D 7?1!. x _ -
I 0. EXPLAIN }IBTIIOD EMPLACEMENT OF MATERIAL. peu fl.. (!.,L... () .5 fo lo 2.J 17t.t,.,,,,_._e ·
Quadrangle No.
WELL DIAGRAM: Draw a detailed sketch of the
well showing tot;! depth, depth and diameter of
screens remaining in the well, gravel interval,
intervals of casing perforations, and depths and
types of fill materials used.
....
r-l --::,
' ~
"
\__
~ l>
';::'
I do hereby certify that this we! cordanc · C 2C, well construction
standards, and that a copy of the record ewe ... / J:
Signalure of person abandoning the well..1..,.L-!<'..:!,::'...~:::::..--...tL-L..:l:.L.-:::.... __ D,ate~ 0 l-
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the _direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway ro_ad identification numbers.
Submit original to the Division of Water Quality, Groundwater Section, one copy to the owner within 30 days
from completion of abandonment.
GW-30 Revised tV99
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AppendixN
I Hot Mix Asphalt
Job Mix Formula
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' NORTH CAROi.INA DEPARTPIENT OF TRANSPORTATION
RALElCHt NORT,M CAROLINA 21611
HDT."lX ASPHALT JOI "lX·FORAULA ____ .,. ____ _
... ..:.-..
BLYTIIE CONST• C0 ■1 INC ■
LAKE NORMAN, NC
TYPE MJXI acsc, TYPE J-Z
,I
PLANT'CERTlFltATIOH NOi Di.-333·
· JOB NIX .FDRlt. ~1. 98-ltltO-OS,l.
EFFECT.IV!! DATEl "07-13-98
.PROJECT NOS
,, . COUKTYl
AG81\EI.AT£ SCURCI!$ AND ILIINO PERtEHTA1iE$
SUPPLIER. \.OCATlON/SOURCE MATERIAL. ----------------------------------' -~---~-·• e.v. HEDRICK CORP ■
lloV, lt[DRICK CORP ■
BREWER SAND CO ■
LAKE NORMAN QUARRY LAK! NORMAN QUARRY
P IliD"ONT, SC PIT
TB,. ·
lhSCRGSe
SAND
33 ■0
41•0
20•0
JMF COMOJNEO· GRADATION
SIEVE SllE I PASSING ------------------
l " 1 1/2"
l "
)/"" 100
1/:!." 98
)/0" 95
HO, ,. l8
8 60
16
40 28 uo 13
NOo zoo !1 ■1
~SPHALT CEMENT SUPPLIERl
TACK COAT SUPPLIER 1 NON-STRIP ADD ■ su,,1.·1E'R1
· MODIFJEII SUPPLIER . 1
COM11FNTSJ TRAOI! SECRET
D.\TE Jl1F VOJDJ
·•·· . ..
OCT.:.~1~ 10135
. "'l,l,.'.
---TOTAL 100.0ll
ASPHALT CEMlNT l(TOT) 6•5
.:RADE
l!ST ASH
PIU4-Z2·
,.All• SP, GV, · 2 ■1t98 ·
LABORATORY SP• r;v. 2 ■361
VOIDS IK TOTA~ "IX 1· 5•5
MIN• I CO~PACTJDN· 95 ■0
"lX TE"~ERATURE:f, 300
FLOW ro.01· 'IN•) . . 10
STAllLITT (LIS•) . . 1900
. NOH STRtP ADOITIVE · I 0•50
flDDIFil:R' .t ·, · .. , '. :· O 00 . . . :· < .. '.'{:.: . •
REVIEWED
ROY F. WESTON, INC .
. · '. . . . ~OEXCEPTIONSTAKEN . ;
CITGO ll~LMlNGTON D EXCEPTIONS TAKEN AS NOTED •.
SPECS~ ' . 0 REVISE AND RESUBMIT .. ARR-ftAt LOf-6900. □ REJECTED ,..DOES NOT COMPLY:
· · · WITH PROJECT REQUIREMENTS
Re~ewed for confonrn1nce wth project design
concept and for compliance with standards of
quality established in the ,Contract Documents.
This review shall not reheve Contractor f~om
A PPRf111'41~ties for correctness of detail. and
!.,\:a,d"illll::tatrlti, •• for deviation from Contract
.. "'""05i:iiinent"requir6,Jlli(nts, e~cept as n~Qllnd ~~ =iM~• "'7'""""' of
By 1~IM-.. _· _, 3, i2-/o 2-
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. Appendix 0
Certificate of Conformance -
Copper Water Tube
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. R.F<1 □1NG
TL8E CO<flOOO!ON --------------------------A Unit of Combrldglrl.ee Industries, Inc.
I certify that all copper tubing manufactured by Reading Tube Corporation meets the applicable
requirements of the specification(s) indicated 9elow. In addition, all copper tubing confonns to the chemical requirements for Copper Alloy UNS No. Cl2200 and is 100 % eddy current tested · in diameters up to 3 .125". Copper tube manufa{:tured by Reading Tube does not contain mercury or come in contact with mercury, mercury compounds or mercury containing devices at any stage in manufacturing, inspection, packaging or shipping.
[X] ASTM B 88 Standard Specification for Seamless Copper Water Tube
[ ] ASTM B 280 Standard Specification for Seamless Copper Tube for Air Conditioning
and Refrigeration Field Service
[ ] ASTM B 306 Standard Specification for Copper Drainage Tube (DWV)'
[ ] ASTM B 819 Standard Specification for Seamless Copper Tube for Medical Gas ' Systems
NFPA 99 C Standard for Health Care Facilities
CGA G-4.1 Cleaning Equipment for Oxygen Service
/J.~M/4,
Bradley~~
.,
Director of Quality and Engineering ,,
NOTARIAL SEAL ,
NAOMI M. PRITCHARD; Notary Public
Ontelaunee Twp., Berks County, ~A
My Commis.sion Expiles 6-1-2000,
7/08/97 · .
Date
\_
iUiVIEWED
·ROY F. WESTON, INe.
JZ'NO EXCEPTIONS TAKEN
0 EXCEPTIONS TAKEN AS NOTED
0 REVISE AND RESUl3MlT ·
0 REJECTED -DOES NOT COMPLY _
WITH PROJECT REQUIREMENTS
·Reviewed for conformance wth prpject design
concept and for compliance with standards of
quality establi~hed in the Contract Docu~ents.
·This review shall not relieve Contra1:tor from
;respo11S1'b.ilities for correctness of detail · and
,dimension, nor for devi:?.tion fro!JI. Contract
Document requirements, except as noted and
:accepted in writing at 1he time of submittal of
·,Engineer.
1By. '}.~~-. ,\111(0\ -r-··o I
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11
'
Appendix P
Approved Shop
Drawings
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'.-1
Submittal
-1
1
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:1 4
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rl 6
1.:;1 7
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9
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11
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L,., 19
rl 20
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:.: .. 23
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' S~ction 4
North BelmontPCE Site
Water System Improvements
Approved Shop Drawings
Contents
Copper Pipe Certification
PVC Tapping Saddles
Corporation Valves ·
Service Saddles
Fire Hydrants
, Megalug Joint Restraints
M.J. DIP Fittings
Valve Boxes
Gate Valves -2"
_ Gate Valves -6", 8"·
,-Tapping Valves -8"
· M.J. Tapping Sleeves
, PVC Pipe -2"
' C900 PVC Pipe -8"
I
· Blue Brute PVC Pipe -8"
DIP -6", 8"
' Pressure Regulators
Valve and Meter Boxes
Curb Stops
Copper Yoke End Connections
' Copper Yoke End Connections
Meter Yokes
Water Meters
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RFd □ING
TU,E~ON --------------------A Uni! or Cambridge-lee Industries, Inc.
I certify that all copper tubing manufactured by Reading Tube Corporation meets the applicable
requirements ofihe specification(s) indicated below. In addition, all copper tubing conforms to the chemical requirements for Copper Alloy UNS No. C 12200 and is 100 % eddy current tested in diameters up to 3.125". Copper tube manufactured by Reading Tube does not contain mercury
or come in contact with mercury, mercury compounds or mercury containing devices at any stage in manufacturing, inspection, packaging or shipping.
[X]
[ l
,[ l
[ l
· ASTM B 88 Standard Specification for Seamless Copper Water Tube
ASTM B 280 Standard Specification for Seamless Copper Tube for Air Conditioning . . ' . and Refrigeration, Field Service
ASTM B 306 Standard Specification for Copper Drainage Tube (DWV)
'
ASTM B 819 Standard Specification foi: Seamless Copper Tube for Medical Gas
' Systems
NFPA 99 C Standard for Health Care Facilities
CGA G-4.1 Cleaning Equipment for Oxygen Service
I
!J..~Mll,
Bradley~~
7/08/97
Date
Director of Quality and Engineering
NOTARIAL SEAL
NAOMI M. PRITCHARD, Notary Public
Ontelaunee Twp. , Berks County. r~
My CommiSsion Expires 6·1·2000
\._
itEVIt!.WED
ROY F. WESTON, INC.
~O EXCEP'f!ONS TAKEN
0 EXCEPTIONS TAKEN AS NOTED
0 REVISE AND RESUl3MlT ·
0 REJECTED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design
concept and for compliance witb st,mdards of
quality established in the Contract Docu111eQts.
This review shall not relieve Contriictor from
;responsibilities for correctness of detail and
,dimension, nor :er devi~tio:i from Contract
Document rcquircnients, except as noted and
:accepted in writing at the time of submittal of
:Engineer.
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f etur11 To Cerro Home
f'e Cop_J2_er Tube Handbook
echnical Data: Tables
1 mblc 2a. TYPE K-Dimensions and nhl'sical characteristics
I Nominal dimensions, inches
Nominal
or
standard
·size, Outside Inside Wall inches diameter diameter thickness
EBI II II .375 .305 .035
. I .500 II .402 II .049 ·ffi1 .625 II .527 II .049
t . j'a I .750 II .652 II .049 l'E1 .875 II .745 II .065
: .. I 1.125 II .995 II .065 , . I ga1 1.375 II 1.245 II .065
• I 11, I l.625 II 1.481 II .072 ,H:JI 2.1 :!5 II 1.959 II .083
: .. · 2 't, I 2.625 II 2.435 II .095 5'81 3.125 II 2.907 II .109 f' 3 't, I 3.625 II 3.385 II .120 ,e:31 4.125 II 3.857 II .134 l ' 5 I 5.125 II 4.805 II .160 tEJI 6.125 II 5.741 II .192
. 8 I 8.125 II 7.583 .271
'· 10 I 10.125 II 9.449 .338.
\ ., --12 I 12.125 II 11.315 I .405
._c/,mcal Data: Tahl<!I r Cop11er Tube Ha11dhJJOk
'
I
· Cross
: sectional
area of
bore,
sq. inches
II ' .073
II .127
II .218
II .334
II .436
II .778
II 1.22
II 1.72
II 3.01
II ·4.66
II 6.64
II 9.00
II 11. 7
II 18.1
II 25.9
II 45.2
II 70.l
II IOI
rage 1 or
Calculated values (based on nominal ~irnensions)
Weight Weight
of tube of tube & Contents of tube only, water per linear ft pounds pounds gg per . per
linear ft. linear ft.
II .145 II .177 ·11 .00051 II .00379 I
II .269 II .324 II .00088 II .00660 I II .344 II .438 II .00151 II .0113 I
II .418 II-.562 II .00232 II .0174 I
II .641 II .829 II .00303 II .0227 I
II .839 II 1.18 II .00540 II .0404 I II 1.04 II 1.57 II .00847 II .0634 I
II 1.36 II 2.10 II .0119 II .0894 I
2.06 II 3.36 II .0209 II .156 I
2.93 II 4.94 II .0324 II .242 I
I 4.00 II 6.87 II .0461 II .345 I
II 5.12 II 9.01 II .0625 II .468 I
II 6.51 II 11.6 II .0813 II .608 I
II · 9.67 II 17.5 II .126 II .940 I
II 13.9 II 25. l II .180 II 1.35 I
II 25.9 II 45.4 II .314 II 2.35 I
II 40.3 II 70.6 II .487 II 3.64 I
II 57.8 II IOI II .701 II 5.25 I
.. I
I
August 1998 Edition. Click here to eo to the CDA Copper Page for possible revisions.
I
1://wv,;w. cerrocu. com ·,~,:a/tab I e2a. html 11/2 ]/200
Nominal or: · Nominal Dimensions, Inches
Standard · Outside Inside Wall Size,;inches Diameter · Diameter Thickness ' '
'I◄ . ,375 ,305 ,035
'I, .500 .402 .049 1/J .625 ,527 .049
¼ ,750 .652 .049 : •fl._ ,875 ,745 .065
-l 1.125 .995 ,065 :111~ .. •, 1,375 1,245 .065
1'1, ' 1.625 1.481 .072
2 2,125 1.959 · .083
2½' 2.625 2.435 ,095
3 3.125 2.907 , 109 3'/,. 3.625 3.385 .120
4 4.125 3.857 .134 .. 5 5.125 4.805 .160
6 6,125 5.741 ,192
8 -8.125 7,583 .271
10 10.125 9.449 ,338 . 12· 12.125 11.315 .405
.. ·Nominal Dimensions, Inches Nomlna1·or Standard , outside . Inside :Wall Size, Inches Diameter Diameter Thickness
' . . 1/1 .375 .315 .030 : %" .500 .430 .035 111. ,625 .545 ,040 'I, ,750 .666 .042 ·.¾' .B75 .785 ,045
1 1.125 1.025 .050
11/4 1.375 1.265 .055
1 'I: I 1.625 1.505 .060
2' 2.125 1.985 .070
· 21h 2.625 2.465 .080 '. 3· 3,125 2,945 .090
3'/t 3.625 3.425 .100
.4 4.125 3,905 , 110 . 5 l :· 5.125 4.875 .125
6 .. 6.125 5,845 .140 8. -8.125 7.725 .200
10: 10.125 9.625 .250
12. 12.125 11.565 .280
Calculated Values (based on nominal dimensions) , . -~. ·, .
Cross Sectional Weight · Wefht . Contents .. o!Tube ·, · • •, a/Tuba Only, ofTube .Water, · • per linear it. , ·: ; ;, Area ot Bore, pounds . pounds · sq inches · Gu ft· ', .· .·'Ga(' ' oer linear ft oar linear ft · · ; , .
.073 .145 ,177 .00051 .00379 .127 .269 .324 .00088 ,00660
.218 .344 .438 ,00151 .0113 ,334 .418 .562 ,00232 .0174 .436 ,641 .829 .00303 .0227
.778 .839 1.18 .00540 .0404 1.22 1.04 1.57 .00847 .0634 1.72 1.36 2,10 .0119 .0894
3,01 2.06 3.36 .0209 .156 4.66 2.93 4.94 .0324 .242 6,64 4,00 6.87 .0461 ,345 9,00 5.12 9.01 .0625 .468 11.7 6.51 11.6 ,0813 .608 1 B.1 9,67 17.5 .126 ,940
25.9 13.9 25.1 , 180 1.35 45,2 25.9 45.4 .314 2.35 70,1 40,3 70.6 .487 3.64
101 57.8 101 .701 5.25
Calculated Values (based on nominal dln:,ensions) · · : : . : : ·
Cross Sectional _weight wefht . Contents olTube . ofTube Only, ofTube Water, . : per linear ft: . : · : . Area or Bore, ·pounds pounds ..... sq inches oer linear ft oar linear ft Cutt·: 'Gal'.
.078 .126 .160 .00054 .00405 .145 .198 .261 ,00101 ,00753 ,233 .285 .386 .00162 .0121 .348 ,362 ,512 .00242 .0181 ,484 .455 .664 .00336 .0251
,825 .655 1.01 ,00573 .0429
1.26 .884 1.43 ,00875 .0555 1.78 1.14 1.91 .0124 .0925
3.09 1.75 3.09 .0215 .161
4,77 2.48 4.54 .0331 .248
6,81 3.33 6.27 .0473 · .354
9.21 4.29 B.27 .0640 .47B 12,0 5.38 10.6 .0833 ·.623
18.7 7,61 15.7 .130 .971
26.8 10.2 21,B .186 1.39
46,9 19,3 39.6 .326 2.44
72,8 30.1 61,6 .506 3.78
105 40.4 85,8 .729 5.45
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PVC FASTTAP® SADDLES
WITH 13/16" COUPON RETAINING PUNCH
FOR USE ON ALL PVC Ar.ID PE MAINS
The FASTT AP® PVC Saddle Tee is the most reliable and easy to use method of adding seNice connections to a plastic main. A live main can be tapped under full pressure. Simply bolt on the FASTTAP® saddle, connect the seNice line and then tap the main with the built-in coupon retaining punch. The punch will seNe as an emergency shut-off valve and may be left in the closed position until seNice is needed.
-""",._:l---0-RING SEAL PVC CAP-
COUPON RETAINING STEEL PUNCH
has alten key socket for easy tapping of main. Provides positive shut-off valve action
RUGGEOPVCCONS,~UCTION -
I --+--
1
• One man installation with hand tools
I PVC COMPRESSION NUT
I I ELASTOMERIC SEAL RING f -I ,--.:.....--,.'-
-316STAINLESSSTEEL
BOLTS AND INSERTS
• Available with compression, solvent or threaded outlets I · Full wrap-around construction supports pipe
• Self-tapping, couoon-retaining, built-in punch provides posiiive '!a Ive action
: • Compression outlet seals positively with pipe wrench .I
I
I Tr,;; .~.::.6 TT"AF::, is your saddle, tapping machine and corporation stop -all in one dependab!e. eccnomicai ,mit
REVIEWED
ROY F. WESTON, INC.
J:(No EXCEPTIONS TAKEN
□ EXCEPTIONS TAKEN AS NOTED
□ REVISE AND RESUBMIT
□ REJECTED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for confornEnc~ wth project design
concept and for cro,r,ipLu11ce with standards of
quality est2u:,;:,",'.i i,: t:,e Contract Documents.
This revie,, , :,,t relieve Contractor from
responsibiliti,·., :·.:t ,:•.:,.:,:c.:•"·.mc.ss of detail and
dimension, r:,::,;-:.-·,, (:'·.i,:icn from Contract
Documpnt ,·," • :'· ·" • r ., •·.:" ,·"""·0 pt as noted and ~-· ... -·!· ~ ........ :.; •':·•........ •
accepted m .,,.,.,::•·: c, ,,;.~ nme of submittal of
Engineer. " ·
s,'J.~,._'r,\,,-u ,h(,,
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5261 STYLE
PVC FASTTAP®
Self Tapping Plastic S_addle Punch Tees For IPS Plastic Mains With 13/16" Coupon Retaining Punch
5261-44-0l13--CO 3/4" IPS MALE PIPE THREAD 5261-44-0l14ID 1" IPS MALE PIPE THREAD 5261-44-1513--CO ~4' IPS FEMALE PIPE THREAD 5261-44-1514-ID 1" IPS FEMALE PIPE THREAD
,)( 5261-.. ·=
5251 .... 25'.J8..(XJ
3/4" CTS (7/8" D.D.) PLASTIC
1"CTS(11/8"0D)PLASTIC
' 5261-44-2513--CO 3/lf' IPS PLASTIC
5261 ·44-2514-ID 1" IPS PLASTIC
Notes:
:t: Plastic compression fittings a're supplied without stiffeners.
For complete catalog number, replace .._,._ with either:
14 for 1" !PS main saddle tee t 15 for 1 1 /4" IP S main saddle tee 16 for 1 1/Z' /PS main saddle tee )r 17 for Z' /PS main saddle tee
18 for 2 112' JPS main saddle tee 19 for 3" IPS main saddle tee 20 for 3 1/2" JPS main saddle t8e· 21 for 4" IPS main saddle tee 23 for 5" !PS main saddle tee· 24 for 6'' JPS main saddle tee 26 for 8" IPS main saddle tee* 27 for 10' JPS main saddle tee• 28 for 12" JPS main saddle tee·
" Wrth stainless steel band clamp .
Notes:
Main size is for 0.0. controlled JPS pipe.
t For 1'• IPS main sizes, 1/2'' coupon retaining punch is furnished.
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5.8 (Mueller Ca.I .1/2" -1" GROUND KEY DESIGN
CORPORATION VALVES Rev. 4-01
H-15008
X
H-15031
3/4"
H-15030
3/4"
H-15009
3/4''
P-15008
3/4"
Ground Key Corporation Valve
Inlet: AWWA taper
(MUELLER "CC") thread
Outlet: MUELLER® 110®
Conductive Compression
Connection for CTS O.D. *
tubing H-15028
II" i : I 112··
Ground Key Corporation Valve
Inlet: AWWA taper
t.. (MUELLER "CC") thread
Outlet: MUELLER 110
Conductive Compression
Connection for CTS O.D. tubing
eighth bend connection
]"
Ground Key Corporation Valve
Inlet: AWWA taper
(MUELLER "CC") thread
Outlet: MUELLER 110
Conductive Compression
Connection for CTS O.D. tubing
quarter bend connection
I"
Ground Key Corporation Valve
Inlet: AWWA taper
(MUELLER "CC") thread
Outlet: MUELLER 110
Compression Connection for
IPS PE* pipe
1··
Ground Key Corporation Valve
Inlet: AWWA taper
(MUELLER "CC") thread
Outlet: MUELLER® Pack Joint
Connection for CTS O.D.*
tubing
!"
H-15029
314"
P-15028
3/4"
"'See charts on pages 5.J0-5.13 for tubing and pipe that may be used on these connections.
Ground Key Corporation Valve
Inlet: AWWA LP. thread
Outlet: MUELLER 110
Conductive Compression
Connection for CTS O.D.*
tubing
ll/4" I I"
Ground Key Corporation Valve
Inlet: AWWA LP. thread
Outlet: MUELLER 110
Compression Connection for
IPS PE* pipe
I"
Ground Key Corporation Valve
Inlet: AWWA LP. thread
Outlet: MUELLER Pack Joint
Connection for CTS O.D. *
tubing
1··
+ Requires minimum ordering qunnti1y. Contacl MUEil.ER Customer Service Center for minimum order rcqWremcnis and availability. NOTE: Sizes shoWrt above represent nominal size of inlet and outlet connections. When two si_zes arc given, the first is size of inlet and the second is size Of outlet. MUELLER• Corporation Valves are manufactured and tested In accordance with ANSI/AWWA CSOQ.
REVIEWED
ROY F. WESTON, INC.
/ .
~ NO EXCEPTIONS TAKEN
0 EXCEPTIONS TAKEN AS NOTED
0 REV1SE AND RESUBMIT
0 REJECTED -DOES NOT coMPL Y
. wrro PROJECT REQUIREMENTS
Reviewed for conformance wth project design
concept and for compliance with standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detail and
dimension, nor for deviation from Contract
Document requirements, except as noted and
accepted in writing at the time of submittal of
E!lg~~erQ..ro
By-£• ~Jµ!L
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1 Self energizing Taper
Seal'"'gaske1 for high
safety factor seal
5Gasket cavity lo fully
entrap gasket
'tlr
5canted earfor
maximum bale bearing
2 Heavy threaded outlet , with NTP or CC Thread 3 High-strength body with
pipe supporting wrap-:!~ _ around design I
4 Heavy hex nut and
washer
-~l
\:\.. t\~([j
Smith-Blair® TaperSeal™ Wrap-around Service Saddles are designed to provide maximum support and re'. inforcemenl of the pipe as the result of nearly 360' contact:· When installed on a pipe with an outside diameter that is equal to or near lo the top of the saddle's O.D. range, the saddle body wraps around the pipe approximately 160'. On a pipe that has an O.D. equal lo or near to the bottom of the' saddle's 0.D. range, the saddle body will wrap around the, pipe approximately 180'.
As the bale bolls are lightened, tangential pull directs the mechanical forces toward and around the pipe, uniformly distributing pressure around the circumference of the pipe', lo support and reinforce ii.
Sealing Qualities
. "-.-,:-n:.
~-.-~uc1101'{ col't'.:> ',,
fl./\1'1 $-'-' I " 311 & 313 j_r ~/ p_prRO'/c.D /1.S \'\011:.0 TaperSeal TM /~[r f\?\'f,Q\J'c.O Q\/c.D ·· 0 \'IO• /I.PPR
Service Saddles 0
Ductile Iron
Stability of Pipe
The wide skirt on Smith-Blair® TaperSeal™ Service Saddle bodies, combined with the wrap-around feature, re-sults in excellent stability of the sadate on the pipe. These two features work together to prevent the saddle from rock-ing or creeping on the pipe, as'might be caused by vibra-tion, pressure or. excessive external loading. This makes possible the use of single bale saddles instead of double bale saddles on many installations, resulting in substantial savings.
Single or Double Bale
The optimum number of bales needed is based on two factors: the pipe O.D. and the outlet size. Double straps are necessary to accommodate for larger pipe 0.D.'s and to equalize gasket pressure around larger outlets.
Easy to Install
For fast, easy installation, Smith-Blair® TaperSea/™ Service Saddles feature a closed lug on one side of the body that holds one end of the strap and its nut in place and acts as a hinge. The other side features an open, canted lug into which the other end oflhe bale and its nut and washer can be slipped. Therefore, there are no loose parts and dis-assembly is not required.
Full Pipe Support--Design Superiority
Smith-Blair® Service Saddles are designed lo hold high ' pressures w·11h just a few pounds of torque applied lo the bale nuts. The unique, pressure-energized TaperSeal™ ' gasket, which seals as the result of both mechanical and , hydrostatic pressures, is contained within a tapered gasket cavity cast into the saddle body. This feature provides a , , positive hydro-mechanical seal, and prevents the gasket from being blown out along the pipe. Al the recommended torque on the bale nuts, Smith-Blair® Service Saddles are designed lo hold pressures in excess of the working pres-sure of the pipe.
Full
ipe Support
I Smith-Bla'1r, Inc. I 30 Globe Ave. I Texarkana I AR 171854 I Ph: 800-643-9705 or 870-773-51271 Fax: [phone] or 870-773-5211
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cc
REVlEWED
ROY f. WESTON, INC.
'l8(No EXCEPTIONS TAKEN
0 EXCEPTIONS TAKEN AS NOTED
0 REVlSE AND RESUBMIT
0 REJECTED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design
concept and for compliance with standards of
quality establi,hed in the Contract Documents.
This review shall not relic.ve Contractor from
responsibilitie, for c•xrcctness of detail and
dimension, ncr for deviation from Contract
Document requ ;,•;;1:cnts, except as noted and
accepted in writing at the time of submittal of ·
Engineer.
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Smith-Blair®
• • • • •
e e e e II~
3/4" and 1" NPT Taps
'" .. ,.,u.s;>, · ··· '::l:'.N:~~=.:1:1::: : ; +wii•·•' •••• '> ...... ... '!I\"SiZ'Et':=':"• :?each(: ........... :i.l\f~~ti"O~:(:I! 11\LhS:: \:: , ...... ... ............ :::::::::::::: =:: ,, 3/4'.',,NPT/20MM,,,,
1-1/4-1-1/2 1.61-1.92 2.9 313-019206-000 2 2.35-2.56 2.5 313-025606-000
2-1/4-2-1/2 2.44-2.91 3.2 313-029106-000 3 2.97-3.54 3.7 313-035406-000 3-4 3.74-4.13 5.5 -. 313-041306-000 4 4.50 5.5 313-045006-000 4 4.14-4.80 5.5 313-048006-000
.4-5 4.74-5.63 6.1 313-056306-000 6 5.94-6.70 6.0 313-066306-000 6 5.94-6.90 6.0 313-069006-000 6 6.84-7.60 7.0 313-076006-000
6-8 7.66-8.08 7.0 313-080806-000 6-8 7.69-8.72 8.2 313-087206-000 6-8 7.69-9.05 8.2 313-090506-000 8-10 8.54-10.10 8.0 313-101006-000
10 10.75-11.10 9.6 · 313-111006-000 10-12 10.64-12.12 9.6 313-121206-000 12 12.75-13.20 14.1 313-132006-000 12-14 12.62-14.32 14.6 313-143206-000 12-14 14.73-15.65 18.0 313-156506-000 14-16 15.95-17.25 18.9 313-172506-000
16-18 17.40-18.88 19.2 313-188806-000 18 18.88-19.50 19.5 313-195006-000 20 21.60 19.5 313-216006-000 24 25.80 19.5 313-25 8006-000
313
Service Saddles
Ductile Iron
Double Bale
.. ::;;·.·.: ::: :::::·::: Mi:itrfoC: ;:::·: ----:::aw: \\\U\~b'~ill\l\1 ;::::::::-:::::::::-::: ,,,a:--o.•,,•
\qty; /H!!!l\$.i.¥~\\::t· \i\l:~il'ri9~\l!\
······:.; .. ,,,, •• MM ••• , •• MM•F .. ,,t\'.;NPT/25MM,•,·• ·
313-019208-000 6 32-40 41-48 313-025608-000 6 50 60-65
313-029108-000 6 57-65 62-73 313-035408-000 6 80 76-89 313-041308-000 6 80-100 95-105 313-045008-000 6 100 114 313-048008-000 6 100 105-122
313-056308-000 ·6 100-125 121-143 313-066308-000 4 150 151-170 313-069008-000 ·4 150 151-175 313-076006-000 4 150 174-193
313-080808-000 4 150-200 195-205 313-087208-000 -4 150-200 198-221 313-090508-000 4 150-200 198-230 313-101008-000 4 200-250 217-256
313-111008-000 4 250 273-282 313-121208-000 4 250-300 271-307 313-132008-000 4 300 324-335 313-143208-000 4 300-350 321-363 313-156508-000 1 300-350 375-397 313-172508-000 ·1 350-400 406-438
313-188808-000 1 400-450 442-479 313-195008-000 1 450 479-495 313-216008-000 1 500 549 313-258008-000 1 600 655
w.:
L)~~c~_:=,::
LK11;?
1.3
1.1
1.5
1.7
2.5
2.5
2.5
2.8
2.7
2.7
3.2
3.2
3.7
3.7
3.9
4.3
4.4
6.5
6.6
8.2
8.6
8.7
8.9
8.9
8.9 .
.• Smith-Blair, Inc. I 30 Globe Ave, I Texarkana I AR I 7_1854 I Ph: 800-64
13-9705. or 870-773-5127 I Fax: [phone] or 870-773-52t1
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313 Service Saddles, Ductile Iron, Double Bale 1-1/4", 1-1/2", 2" and 2-1/2" NPT Taps
....... """"•U:S."'··'' ·
TN~Vri:: +na:6 :wi:: •.••.•.•••.••• '' •·•• Ii ::::s·fa:i,;;: \\d~_ange_::\ each )ij_~~~~ '.!)f;!nc.~~s::i :"Ll&S:
1'1/4;' N~/J2MM ·1,ii2''Niif141iiJiii,i
2 2.35-2.56 3.1 313-025610-000 31 3-025612-000
3 2.97-3.54 5.1 313-035410-000 313-035412-000
3.4 3.74-4.13 7.5 313-041310-000 313-041312-000 4 4.50 5.5 313-045010-000 313-045012-000 4 4.14-4.80 5.5 313-048010-000 313-048012-000 4-5 4.47-5.14 8.0 313-051410-000 313-051412-000 4-5 5.00-5.63 8.6 313-056310-000 313-056312-000 6 5.94-6.70 9.2 313-066310-000 313-066312-000
6 5.94-6.90 9.2 313-069010-000 313-069012-000 6 6.84-7.60 7.2 313-076010-000 313-076012-000 6-8 7.66-8.08 7.4 313-080810-000 313-080812-000 6-8 7.69-8.72 10.5 313-087210-000 313-087212-000 6-8 7.69-9.05 10.5 313-090510-000 313-090512-000 8-10 8.54-10.10 8.9 ,. .. ,._ .. ,..,.n•n.nnn 313-101012-000
10 10.75-11.10 9.6 313-111010-000 313-111012-000 10-12 10.64-12.12 11.0 313-121210-000 313-121212-000 12 12.75-13.20 14.1 313-132010-000 313-132012-000 12-14 12.62-14.32 14.1 313-143210-000 313-143212-000
12-14 14.73-15.65 18.0 313-156210-000 313-156212-000 14-16 15.95-17.25 18.9 313-172510-000 313-172512-000 16-18 17.40-18.88 19.2 313-188810-000 313-188812-000 18 18.88-19.50 19.5 313-195010-000 313-195012-000 20 21.60 19.5 313-216010-000 313-216012-000 24 25.80 19.5 313-258010-000 313-258012-000
3" and 4" NPT Taps
::,:::s,ze:: ;:::in~hC~
6
6
6
8-10
10
10-12
12
12-14
12-14
14-16
16
16-18
18
5.94-6.90
6.84-7.60
7.66-8.08
8.54-10.10
10.75-11.10
10.64-12.12
12. 75-13.20
12.62-14.32
14. 73-15.65
15.98-16.59
17.25-17.80
17.40-18.88
18.88-19.50
::\ttifF/
:•::•••••::., :::•",3'.'.•NPT/80MM
10.4 313-066317-000
12.9 313-076017-000
13.0 , 313-080817-000
15.0 313-101017-000
14.0 See 357's page 27
14.0 313-121217-000
18.0 See 357's page 27
18.0 313-143217-000
27.8 313-156517-000
28.2 313-165917-000
28.8 313-178017-000
29.6 313-188817-000
29.8 313-195017-000
.... • .. " ....................... ' " .... , :•.:.i:.,•:.:. ' ::Metric::.:::· .
lg l~W} ?NOi=n/ lb'. oO >:s·iZ8!::: :i/,~~rjg·~ HMMY :••'.:MMi 2'' NPT/S0MM '2-1/2~ NPT/65M~ .....
N.A. N.A. 6 50 60-65 313-035414-000 N.A. 6 80 76-89
313-041314-000 . 313-041316-000 6 80-100 95-115
313-045014-000 313-.045016-000 6 100 114 313-048014-000 313-048016-000 6 100 105-122 313-051414-000 313-051416-000 6 100-125 114-130 313-056314-000 313-056316-000 4 100-125 121-143
313-066314-000 313-066316-000 4 150 151-170
313-069014-000 313-069016-000 4 150 151-175
313-076014-000 313-076016-000 4 150 174-193
313-080814-000 313-080816-000 4 150-200 195-205
313-087214-000 313-087216-000 4 150-200 198-221
313,090514-000 313-090516-000 4 150-200 198-230 , .. _. '. 313-1010'6-000 4 ?fi0-250 217-256
313-111014-000 313-111016-000 4 250 273-282 313-121214-000 313-121216-000 4 250-300 271-307 313-132014-000 313-132016-000 4 300 324-355 313-143214-000 313-143216-000 4 300-350 321-363
313-156214-000 313-156216-000 1 300-350 375-397
313-172514-000 313-172516-000 1 350-400 406-438
313-188814-000 313-188816-000 1 400-450 442-479 313-195014-000 313-195016-000 1 450 479-495 313-216014-000 313-216016-000 1 500 500-549 313-258014-000 313-258016-000 1 600 655
· ·· ··::::·::::;;,Metric,,::::··
N.A.
313-076018-000
313-080818-000
313-101018-000
See 357's page 27
313-121218-000
See 357's page 27
313-143218-000
313-156518-000
313-165918-000
313-178018-000.
313-188818-000
313-195018-000
4
4
2
3
2
2
2
150 151-175
150 174-193
150-200 195-205
200-250 217-256
250-300 271-307
300-350 321-363
300-350 375-397
350-400 406-421
400 439-452
400-450 442-479
450' 479-495
1/2'' 1.P. Taps can be accommodated by inserting a bushing In 3/4w taps.
••wt·
Ei:iCh!
kl(
1.4
2.3
3.4
2.5
2.5
3.0
3.9
4.2
4.2
3.3
3.4
4.8
4.8
4.0
4.3
5.0
6.5
6.4
8.2
8.6
8.7
8.9
8.9
8.9
4.7
5.9
5.9
6.8
6.4
8.2
12.6
12.8
13
13.4
13.5
Smilh-Blair, Inc. j 30 Globe Ave. j Texarkana I AR I71854 I Ph: 800-643-9705 or 870-773-5127 I Fax: 800-<348-6792 or 870-773-5211
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313 Service Saddles, Ductile Iron, Double Bale 5/8", 3/4" and 1" CC Taps .... ............... ,:: .. •::::;:u;s,•:>•:: .. ,····· ..
\j(/NOni';ti :: .. :•o::o:•::::: .. ,,:::wv .. ·· ·····: "' ::: ·=:: :: =:::: ::: =.=:: ::: = Cataloq ,Number.-=:/=:= .. •:,: ·.·.: ·.::: ;:: ;::,;:~: :;:-: ·.· .. :::--,,:stze:·::,, n<~~:~e~ti :L /g~a,.: ::::::::-::::::::::::::::.::: ::::::::-:::-::::-:.:::::::::::::-:;:-:-::: :::n+1•~21is~M•·• iill'irl~ilB~::i ::(\\lrich8S"(\\ ::: C\\:LibSj\ : ~t'. ~<:h st.lM .. ••·3/~;'CC:l~ldr.,!;::•·• ..
1-114-1-112 1.61-1.92 2.9 313-019205-000 313-019207-000 313-019209-000 2 2.35-2.56 2.5 313-025605-000 313-025607-000 313-025609-000
2-1/4-2/12 2.44-2.91 32 313-029105-000 313-029107-000 313-029109-000 3 2.97-3.54 3.7 313-035405-000 313-035407-000 313-035409-000 3-4 3.74-4.13 5.5 313-041305-000 313•041307-000 313-041309-000 4 4.50 5.5 313-045005-000 31 J.045007-000 313-045009-000 4 4.14-4.80 5.5 313-048005-000 313-048007-000 313-048009-000 4-5 4.74-5.63 6.1 313-056305-000 313-056307-000 313-056309-000 6 5.94-6.70 '6.0 313,066305-000 313-066307-000 313-066309-000 6 5.94-6.90 6.0 313-069005-000 313-069007,000 313,069009-000 6 6.84-7.60 7.0 313-076005-000 313-076007-000 313-076009-000 6-8 7.66-8.08 7.0 313-080805-000 313-080807-000 313-080809-000 6-8 7.69-8.72 8.2 313-087205-000 313-087207-000 313-087209-000 6-8 7.69-9.05 8.2 313-090505-000 313-090507-000 313-090509-000 8-10 8.54-10.10 8.0 313-101005-000 l( 313-101007-000 313-101009-000
10 10.75-11:10 9.6 313-111005-000 313-111007-000 313-111009-000 10-12 10.64-12.12 9.6 313-121205-000 313-121207-000 313-121209-000 12 12.75-13.20 14.1 313-132005-000 313-132007-000 313-132009-000 12-14 12.62-14.32 14;6 313-143205-000 313-143207 ,000 313-143209-000 12-14 14.73-15.65 18.0 313-156505-000 313-156507-000 313-156509-000 14-16 15.95-17.25 18.9 313-172505-000 313-172507-000 313-172509-000 16-18 17.40-18.88 19.2 313-188805-000 313-188807-000 313-188809-000 18 18.88-19.50 19.5 313-195005-000 313-195007-000 313-195009-000 20 21.60 19.5 313-216005-000 313-216007-000 313-216009-000 24 25.80 19.5 313-258005-000 313-2580_07-000 313-258009-000
, :I 1-1/4", 1-1/2" and 2" CC Taps ·· ...................... , u: s;::•:: .... ...
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•• . ,,._.:
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I
::Norn:::.:
n;s·ii~H
=mc11es=:
2
3
3-4
4
4
4-5
4-5
6
6
6
6-8
6-8
6-8
8-10
10
10-12
12
12-14
12-14
14-16
16-18
18
20
24
::••• .. ·••.o;o.::,• .. •··
::i)1l1l~ti~t:J!iiii1
2.35-2.56
2.97-3.54
3.74-4.13
4.50 ·
4.14-4.80
4.74-5.14
5.00-5.63
5.94-6.70
5.94-6.90
6.84-7.60
7.66-8.08
7.69-8.72
7.69-9.05
8.54-10.10
10.75-11.10
10.64-12.12
12.75-13.20
12.62-14.32
14.73-15.65
15.95-17.25
17.40-18.88
18.88-19.50
21.60
25.80
::;:..wt;: .. .. ,::::··:::::::::=.::::::::_:;:::::::::::catalo~i-NUhll:iOi::: ::::::::::::::::::-:::::;·::::::··:·· /iE3~h= .. , .. , ........ , ....... , ... , .... ,. :::;:.:·:::;:::::::::;·::·::·:·;-:;::::::;; :::.::::.:::::.::·::.:-::::-:::::-:::::::·::::: ?ifi~'.\ ••1:J,,/.cch2111111• ,''7112''.!;C/~OM_M_••·• ::: ::•2'!,CC/50MM, .. •:: ... :.:.:, ..
3.1 313-025611-000 NA. N.A. 5.1 313-035411-000 313-035413-000 N.A.
7.5 313-041311-000 313-041313-000 313-041315-000 5.5 313-045011-000 313-045013-000 313-045015-000
5.5 313-048011-000 313-048013,000 313-048015-000 8.0 313-051411-000 313-051413-000 313-051415-000 8.6 313-056311-000 313-056313-000 313-056315-000 9.2 313,066311-000 313-066313-000 313-066315-000 9.2 313-069011-000 313-069013-000 313-069015-000 72 313-076011-000 313-076013-000 313-076015-000 7.4 313-080811-000 313-080813-000 313-080815-000 10.5 313-087211-000 313-087213-000 N.A. 10.5 313-090511-000 313-090513-000 N.A. 8.9 313-101011-000 313-101013-000 313-101015-000 9.6 313-111011-000 313-111013-000 313-111015•000 11 :0 313-121211-000 313-121213-000 313-121215-000 14.0 313-132011-000 313-132013-000 313-132015-000 14.1 313-143211-000 313-143213-000 313-143215-000
18.0 313-156511-000 313-156513-000 313-156515-000 18.9 313-172511-000 313-172513-000 313-172515-000 19.2 313-188811-000 313-188813-000 313-188815-000 19.5 313-195011-000 313-195013-000 313-195015-000
19.5 313-216011-000 313-216013-000 313-216015-000 19.5 313-258011-000 313-258013-000 313-258015-000
:::,:::::::::::!:::-Metric:::::======···
!iCillUf! :1\ir~"!!:: ..,,o::o:: .. ,· :;v1 .
91y: :{Rii09'8? ·::Ea"Cfr' :: MM •••••• MM•· ••. .iii( ...... . ...
6 32-40 41-48 1.3 6 50 60-65 1.1
6 57-65 62-73 1.5
6 80 76-89 1.7
6 80-100 95-105 2.5
6 100 114 2.5
6 100 105-122 2.5 6 100-125 121-143 2.8 4 150 151-170 2.7
4 150 151-175 2.7 4 150 174-193 3.2
4 150-200 195-205 3.2 4 150-200 198-221 3.7 4 150-200 198-230 3.7
4 200-250 ?17-?5R 3.6
4 250 273-283 4.4 4 250-300 271-307 4.4 4 300 324-335 6.5 4 300-350 321-363 6.6 1 300-350 375-392 8.2 1 350-400 406-438 8.6
1 400-450 442-479 8.7 1 450 479-495 8.9 1 500 549 8.9 1 600 655 8.9
····:::::::: =:::::Metric::::,····
cinl =i!i:.NOfu'.·ii ::':o::o.,::.• •·•wt ... !\T}~ii~'. <~-~~9f\i ::r::t: (:.liy\ ::•:MM: •:••••MM::;::• ..
6 50 60-65 1.4 6 80 76-89 2.3
6 80-100 95-115 3.4 6 100 114 2.5 6 100 105-122 2.5 6 100-125 114-130 3.2 4 100-125 121-143 3.9 4 150 1S1.17" 4.2
4 150 151-175 42 4 150 174-193 3.3 4 150-200 195-205 3.4
4 150-200 198-221 4.8
4 150-200 198-230 4.8 4 200-250 ')17_ ... ~~ 4.0
4 250 273-282 5.0
4 250-300 271-307 5.0 4 300 324-335 6.3
4 300-350 121-363 6.4
1 300-350 375-397 8.2 1 350-400 406-438 8.6 1 400-450 442-479 8.7
1 450 479-495 8.9
1 500 549 8.9
1. 600 OH 8.9 I
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Smith-Blair, lrrc. I 30 Globe Ave. J Texarkana I AR 1718541 Ph: 800-6,43-9705 or 870-773-51271 Fax: [phone] or 870-773-5211
L no~ I V.-4 · !Mueller Ca.I MUELLER® SUPER CENTURION® \2)
FIRE HYDRANT
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□ Super Centurion 2SffTh1 3-way catalog numbers (approved to UL 262, FM 1120/1130, ANSI/A WW A CS0Z Standards)-A-421 4-l/2" main valve opening three way (two hose nozzles and one .. pumper nozzle)· ~ A-423 5-1/4" main valve opening three way (two hose nozzles and one pumper nozzle) Super Centurion 2oon.1 2-way catalog numbers (approved to ANSI/A WW A CS0Z Standards)-A-420 4-1/211 main valve opening two way (two hose nozzles) A-422 5-1/4" main valve opening two way (two hose nozzles) A-425 5-1/4" main valve opening two way (two pumper nozzles) Super Centurion 2oon.1 I-way catalog number (approved to ANSI/A WW A CS0Z Standards)-,r:-~i•~\jC1\0i'\ A-424 4-1/2" main valve opening one way (one pumpernozzle) \:. cQ\'1-c " D IO year limited warranty on material and workmanship Rf>-l'l s-S1 f\ i .
D Meets all applicable parts of ANSI/A WWA C502 Standard 1 .4f r,.pPR~%1 r,.$ N01E.O o Post type dry barrel design O ~,prR ,,poRO\/E.0
"01 " ' o Dry top design with O-ring sealed oil reservoir O 1'1
□ Traffic feature with stainless steel safety stern coupling
□ Compression-type main valve closes with pressure for positive seal; it is made of rubber and is conveniently reversible providing a spare for long service life (Patent Pending) □ Operating nut available in wide variety ofsh~pes and sizes--ope~ left or right □ Field replaceable hose and pumper nozzles
□ Hose and pumper nozzles have large radius, full flow openings for low friction loss □ Contoured shoe is designed for full flow
□ Dual bronze drain valves provide effective barrel drainage
□ 250 psig ( I 723 kPa) maximum working pressure. 500 psig (3447 k.Pa) static test pressure for 3-way hydrants; 200 psig (1379 kPn) maximwn working pressure, 400 psig (1758 kPa)
Dimensions
Mechanical joint -\. 1,l:Ji~~. -standard and
D-150 \-.. tli :{~!·-"1
Flange
T~--~
TI': ·rt: . ..-.:~.
~:i~~;~~~~ 'W• -/~.-~:
no tool need ~/ i~ ', ', on bnck side ·--; 1 +
1 ,.. __ _,
ofboltfor r j /;/
. ensicr inst.'lll~tio~ ~-:¼,-~,1/ /
Front view detail ~ of Mechanical joint · (Standard only) \~--r
. '◊
illl Vertical
Flange• !-}~~:--!
• 4" Vertical shoe nvnilnblc for A-420 nnd A--421 hydrants.
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,....._I _n.......,u•Ni□E(LER® SUPER CENTURION'®
FIRE HYDRANT PARTS
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MUELLER Super Centurion Fire Hydrant Parts
Cat. / Description part# JMaterial I Material standard
A-1 I Oncratimt. nul Bronze ASTM 8584 A-2 / We.:itherc.an <not shown: used onlv on nn-..J 988 models) Cast iron ASTM A!26 CL.B A-3 \ Hold dowu nut O-rini.z Rubber ASfM D2000 BUNA N A-4 I Hold do..,,n mn Coor shown: used univ on ""'·191111 mo:xiehc) Bronze ASTM 8584 A-5 Bonnet O-rinu Rubber ASTM 02000 BUNA N A-o Anti-friction washer Cdcon
A-7 Oilnlug Brass ASTM 816 A-8 Bmuiet Cast iron ASTM Al26 CL.B A-9 Bonnet bolt and nut Sted ASTM AJ07 Plated A-10 Bonnet O-riug (!997urnl newer J;;:{cmodels: 111! pre-Rubber ASTM 02000 BUNA N ! 997 moJcls urii.J !-wnv 1111d 2-wuv els !ll1ve tla1 in~~kct)
A-II Unncr stem Steel ASTM A576 GR.B A-12 Stem O-rin11 Rubber ASTM 02000 BUNA N A-13 Nozzle lock Stainless steel ASTM A276 A-14 Pumner nozzle Bronze ASTM 8584 A•IS Pumner nozzle 11asket Rubber ASTM D2000 Neonreoe A.Jfi Pumner nozzle O-ri1111 Rubber ASTM 02000 BUNA N A.J7 Pumner nozzle cap Cast ir□n ASTM Al26 CL.B A·IR Hose nozzle Bronze ASTM 8584 A-19 Hose nozzle i.tasket Rubber ASTM D2000 Neonn:ne A-20 Hose nozzle Q.Jinl! Rubber ASTM D2000 BUNA N A-21 Hose nozzle can Cast iron ASTM Al26 CL.B A-22 Can chain Steel P!ated · A-23 Chain rinii Steel Plated A-24 Urmer barrel Jess nozzles Cast iron ASTM A 126 CL.B A•25 Safctv counlin , Stainless steel ASTM AS90 A-26 Safetv fla.iu!e bolt and nut Steel ASTM A307 Pl::ited A-27 S::ifci lla.t1He O-ring ( 1997 11ml newer mixlels; Rubber Cellulose n~-l 97 muc.lels have !11111!11.~kct)
A-28 Safctv flw1l!e Cast iron ASTM'A126 CL.B A-29 Cotter nin Stainless steel ASTM A276 A-JO I Clevis nin Stainless steel ASTM A276 A-JI Lower stem Steel ASTM A576 GRB A-32 Lower barrel Cast iron ASTM A 126 CL.B A-JJ Stem nin Staiu!ess steel ASTM A.276 A-J4 Drain valve facim1 Plauic A-JS Drain valve screw Stainless steel ASTM A276 A-36 Unner valve nlate (includes A·H nnc.1 A·J5) Bronze ASTM 8584 A-37 Shoe bolt and uut Steel ,· ASTM 'AJ07 Plated A-38 Drain ring housinM O•ring (19Q7 and newer models; Rubber ASTM D2000 8UNA N I nre-1997 models iave sauarc 1U1sket)
A-39 Scat rin11 ton O-ri1111. Rubber ASTM D2000 8UNA N A-40 Drain rin11. housinv. Casi iron ASTM Al26CL.B A-41 Drain rim! housin11 boll ::1.11d nut (not shown; usec.l only on nre-19g7 model11vc.lnmts) Steel ASTM AJ07 Plated
A-42 Drain rilll! Bronze ASTM 8584 A-4l Seat riu11. Bronze ASTM 8584 A-44 Scat ri1111: bottom 0-rilll! Rubber ASTM 02000 BUNA N A-45• Reversible maiu valve (1997anJ newer models only; Rubber ASTM D2000 pre-1997 moc.lel~ U.'IC non·~vcrsiblc main valve urd lower vulve nlaic • not i>OOW!l)
A-46 Lower valve plate ( J 997 und newer moc.lels for Casi iron ASTM Al26 CL.B rever.nble m11in v11lve: rrc• 1997 moc.leL~ huve non-~\'ersible main vn ve. not shown)
A-47 ! Can nut seal Rubber ASTM02000 A-48 Lock washer Stainless steel ASTM A276 A-49 Lower valve nlate nut Cast iron ASTM Al26 CL.B A-50 ;,Shoe ' Cast iron ASTM Al26 CL.B A-84 Hold do'I\Tl nut Bronze ASTM 8584 A-85 Weather seal Rubber ASTMD2000 A-51 I 10.5 oz. hvdrw1t lubrica1inl! oil(uol shown)
.' Pre-1997 models may be l!fll!raded lo use the reversible maiu valve by also rerlaciug the lower ·-· '{.alve plate with the 1997 1iiode!. . •-·
SEEP AGE 9.24 FOR ORDERING INSTRUCTIONS
(Mueller Ca.I 9.5
REV. 4.gg
A-1
-A-2
A'85
A-3
A-4
A-84
.A-5
A-6
~~:; ~_,,r-A-9
A-10
A-11
A-12
A-13
A-14
.A-15
A-16
A-17
A-18
,~u.,-c--A-19
A-20
A-21
A-22
N-----A-23
N A-24
A-25
A-26
A'27
t~---"--J:t-~---A-28 T. A-29
"++---f+------A-30
f-----s':l------A-31
r-i-----'--A-32
A-33
A-34
A-35
A-36
A-37
A-38
A.'39
>>~__:...--A-40
~ ---A-41 . A-42
A-43
A,44
A-45
A-46
A-47
A-48
A-49
A-50
A-51
REVIEWED
ROY F. WESTON, INC.
t3$Jo EXCEPTIONS TAKEN 0 EXCEPTIONS TAKEN AS NOTED 0 REVISE AND RESUBMIT 0 REJECTED..: DOES NOT COMPLY WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design concept and fo:· compliance with standards of quality estabEs!ieJ in the Contract Documents. This review sh;;;; :iot relieve Contractor from responsibilities Ic:-r correctness of detail and dimensiori, no;-i•)I' dr•.-.,;,t_;nn from Contract Document requ;rc::ic,·.,:;, except as noted and accepted in writing at th:; time of submittal of Enginee .
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...:..·...:'•L~:......:. .::.~;:,-__ ,-:C.\i _,_N
lchanical joint reStraint shc.:J '.:e inc:r;:;crated in the design of the
er gland ar.d shail induC::e J. ~estraining mechanism which, when
:tuated, imparts multiple weC,;i,.-;: ::!C"..lon against the pipe, increasing
; lsistance as the presscre ir.c:--~=.ses. f_iexibility of the joint shall be _
ined after burial. Gicnds shai! be manufactured of ductile iron
rming to ASTM A 536-80. Kesucining devices shall be of ductile
•• 1 eat treated to a minimum harc'r.ess of 370 BHN.-Dimensions of
e gland shail be such that it c:m be used with the standardized
l nical joint t:ell and tee-head belts conforming to MSVAWWA
1 and ANS'iJAWWA Ci5.3/A2i.53 of latest revision. Twist-off nuts
e used to insure proper ac::.mting of the restraining devices.
The mechanicai joint res::raim device shail have a working pressure of
1st 250 psi with a minimum safecy factor of 2:1 and shall be EEM
nc., MEGrJ..UG or E!quai. .
--t~ . 6
rl
" a 10
12
14
16
18
1103 6.50 350
1104 7 .00 350
1106 12.00 350
I i08 15.50 350
1110 :!4.25 350
1112 J.J.00 350
1114 .JIL50 350
1116 56.00 350
! 118 59.C0 250
i 120 7.1_50 250
112.-1 139.00 250
! 1.J0 I99.G0 250
1136 ~J0.00 250
11-12 ::aJ.co 2so
! 148 .1;-2.IJO 250
Test pressures above the r;!:ed pressures shown. consult the
\ ering depanment cf EEA.l, iron, lnc., for recommendations.
:AA-Sea! gaskets are provided with the 30",through 48~ MEGALUGS. ·1rovided with the 42" and 46" si.:es are extra length T-bolts. The
:'. ts and baits are provided tc fadit.:ite easier assembly of the i nical joint and are required on the above referenced sizes to
l.:,~:-,1 the pressure rntings and E.!fer:1 fad.ors shown.
, :or projects using large diarr.e~'.!r :-estr;:i.ints. please contact this office
;Ir design recommendatior:s.
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[½,
I ::,-,
i ,,,/_c
"\1//~Fi
REAR VIEW FRONT VIEW
i M l 17 I -) ·! i__,;._ 0.75
K, ~-'-...1---~
I : 0.12
SECTION A-A
SERIES C D
1103 4,84: 227
1104 5.92 : 227
1\ 1106 ·i 8.02 · 227
.1(1108 I 10.11 : 2J! 1110 '1212: 2J'i
1112 14.32 ! 2J7
1114 16.40 . 2.59
1115 18.50 ; 2.69
lll8 20.60 : 2.59
1120 22.iO I 2.69
1124 26.SO i 2.72
1130 33.29 ! 3.38
1136 39.!9 ; J.38
1142 45.79 i 4.56
I !48 52.09 : 4.56
I --·,--
! I i
F IC
F .~
G) NUT @SPACER
. @ SHOULDER BOLT @'NEDGE
X NO.OF
IYEDG.ES
6
d
!O
i2
!2
" 16
2D
2-1
25
32
i i'!O. CF· p
BOLTS
4
4 6
6
' B :o
12
i2
14
:6
20
24 :a
32
9.36 ·
' 10.20 :
= !2.30:
' !'i.45
-: 16.:0 ·
18.60
· 20.t4 -. 22.60 .
' 24.70 ,
I 25.CQ I
: ~2.9~ ;
1 ~9.l, !
i ..\5.-ii I i 53.87 ;
· 62.: 7 !
P WiNCJTS ·
m'ISTED · arr
9.06
9.90 :2.co !4,;:
16.20 :s.::o
20.9.:
22.SO
25.CO 27.10
32.!:4 ;asi
45.:i 5;5
5i.37
All. Dll1IENSIONS ARE IN INCHES Ai'YD ARE SUBJECT TO CHAi'!'GE WITHOUT l'IOT!CE
LISTIN_GS AND APPROVALS FOR SERIES 1 I 00 MEGALUG
Sizes 3H throuah 2-t" are listed bv Under,vriters Laboratories, Inc .•
category J-IJKF .:-Fittings. Ret.'.!iner Type," with a deflection c.ng!e cf five
degrees. The listing file nµr:,ber is E..'<2836. Sizes 3'' throl..!gh 12~ are
Factory Mutual approved. · ·
'.{2
REVIEWED
ROY F. WESTON, INC. ~O EXCEPTIONS TAKEN 'B EXCEPTIONS TAKEN AS NOTED 0 REVISE AND RESUBMIT 0 REJECTED -DOES NOT COMPLY wrru PROJECT REQUfREMENTS
Reviewed for conformance wth project design concept and for compliance with standards of quality estabbhed in the Contract Documents. This ·review sliaJJ not relieve Contractor from responsibilities hr ccrrectness of detail and dimension, 11v.· 1,,, deviation from Contract Document r~r,:,ire,,,,:nt~, except as noted and accepted in writi~g ,,t the time of submittal of
Enginee . --fy ........ .......,.'7;-~~
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Tyler /Union MECHANICAL JOINT Cl 53 DUCTILE IRON COMPACT FITTINGS Sizes 3" thru 12" UL listed For Fire Moin Equipment
SAMPLE SPECIFICATIONS
3" THRU 24" MECHANICAL JOINT DUCTILE IRON FITTINGS shall be produced in the USA.in accordance
with alt applicable terms and provisions or ANSI/ AWWA C7 53/ A27 .53 and ANSI/ AWWA C171 / A21.11. All Ductile Iron Mechanicc1I Joint (Only) Fittings are rated for 350 PSI working pressure, unless otherwise indicated. NOTE: Fittings arc cement-lined and seal-coated in accordance with ANSI/AWWA C104/A21.4; also available double cement-lined or bare. All coated fittings meet r~quircments of NSF-61. See list price sheet for details.
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JOINT DIMENSIONS IN INCHES
Size A Dia. B C Dia. D Dia. F Dia. J Dia. K1 Dia. K2 Dia.
3 3.96 2.50 4.84 4.94. 4.06 6.19 7.62 7 .69 4 4.80 2.50 5.92 6.02 4.90 7.50 9.06 9.12 6 6.90 2.50 8.02 · . 8.12 7.00 9.50 11 .06 11 .12 8 9.05 2.50 10.17 10.27 9.15 11.75 · 12.31 · 13,37 10. 11 .. 1 o 2.50 12.22 12.34 11.20 14.00 15 .62 15.62 12 13.20 2.50 14.32 14.44 13.30 16.25 17.88 . 1_7.88 14 15.30 3.50 16.40 16.54 15.44 18.75 20.37 20.25 16 17.40 3.50 18.50. 18.64 17.54 21.00 22.56 22.50 18 19.50 3.50 20.60 20.74 19.64 23.25 24.83 24.75 20 21.60 3.50 22.70 22.84 21.74 25.50 27.08 27.08 24 25.80 3.50 26.90 27.04 25.94 30.00 31.58 31.50
BENDS
90° Bends (1 /4) 45° Bends 11 /8)
Dimensions Dimensions Size T A R Weight A R Weight
3 .34 4.5 4.0 20 2.00 3.62 16 4 .35 5.0 4.5 26 2.49 4.81 22 6 .37 6.5 6.0 48 3.50 7.25 40 8 .39 7.5 7.0 68 4.00 8.44 59 10 .41 9.5 9.0 136 5.07 10.88 86 12 .43 10.5 10.0 141 5.98 13.25 109 14 .51 12.0 17 .5 220 5.50 12.06 764 16 .52 13.0 12.5 264 5.98 13.25 202 78 .59 15 .5 14 .0 470 7.50 14.50 325 20 .60 17.0 15.5 505 8.00 16.88 368 24 .62 20.0 18 .5 695 9.00 18.12 487 ...
J D C •
L M s T
.58 .62 .39 .33
.60 .75 .39 .34
.63 .BB .43 .36
.66 1.00 .45 .38
.70 1.00 .47 .40
.73 1.00 .49 .42
.79 1.25 .56 .47
.85 1.31 .57 .50
1.00 1.38 .68 .54
1.02 1.44 .69 .57
1.02 1.56 .75 .61
22'/,0 Bends 11/16)
Dimensions
A R Weight
1.50 4.98 15
1.82 6.66 21
2.59 · 10.50 37
2.85 11.80 51
3.35 14.35 67
3.86 16.90 90
3.93 17.25 148
3,98 17.50 179
7.50 30.19 292
8.50 35.19 364
9.00 37 .69 481
2 Tyler Pipe/Utilities Division~ P.O. Box 2027 • Tyler. Texas 75710 • [phone] Union Foundry Company• P.O. Box 309 • Anniston, Alabama 36202 • [phone]
-1
T
7
. ,,
BOLTS
X Dia. Size No.
'I, 5/ax3 4
'I• '/,x3'/, 4 'I, J/4x31/2 6
'I• '/.x3'/, 6 'I, J/4xJ1/2 8
'I' '/,x3'/, 8 'I, ½x4 10
'I• '/,x4 12 'I, 3/~x4 12
'I' '/,x4 14 ,;, 3/~x4½ 16
11 1/,0 11/32)
Dimensions
A R Weight
1.25 7.62 15
1.55 10.70 20
1.81 13.26 33
2.06 15.80 48
2.32 -18.36 61
2.56 20.90 79
2.59 21.25 133
2.62 21.50 159
REVIEWED
ROY .F. WESTON, INC.
~O EXCEPTIONS TAKEN .
'[] EXCEPTIONS TAKEN AS NOTED
□ REVISE AND RESUBMIT
□ REJECTED -DOES NOT COMPLY
WITH PI\OJECT REQUIREMENTS
Reviewed for conformr.nce wth project design
concept and for r:n:npliance with standards of
quality estab), ,},,:•.,j in the Contract Documents.
This review .si:ail m''. relieve· Contractor from
responsibili,:,;,; for ci:-rrectness of detail and .
dimension, ,•,x, f ,,· iJ,:v::t:ion from Contract
Document rcq,.;;.-,,,_,;,;::,, except as noted and
accepted in wrr,\:,:::; ,;: the _time of submittal of
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Round Head Roat'lway
Eo~es ~Niih 4¼" Shalt
DROP COVER
Figure 9.111
LOCK COVER
Figure B-i15
OPEN BASE FLANGE BASE
ROADWAY BOX ROADWAY BOX
Figure 8-112 Figure 8-117
Extension Pieces For
4 ¼ "Roadway BolCes
EXTENSION PIECE
Figur1;1 6-118
Two Piece Valve Boxes
5¼" Shaft
SCREW TYPE OR SLIP TYPE
= =
EXTENSION
PIECE
SCREW TYPE
Figure 8-123
SLIP TYPE
8-127
EXTENSION
PIECE
SL!P TYPE
F"1gure 6-128
(B)
Open Flange Appro•lmll1• Complete B11se Base
140-0 40-Q
141-Q 41-Q
142-Q 42-Q
142-R 42-R
143-R 43-R.
4 114 Round Covers
4 ¼ Round Lock Covers
Slz.e,
49
Screw Slip Approximate
E.t•n1lan ,, .. Type • Inch,,
k 461-S 461-A 18-24
56J-S 562-A 24-36
564-S 564-A ~8
664-S 664-A 36--ilO
666-S 666-A 48-72
668-S 668-A 60;-84
btendon
h1ch.,,
18-24
22-30
30-36
30-42
36-18
WI.
51
54
60
70
74
8
10
lncr,u•• length
Apprulmotely
18"
SCREW TYPE OR SLIP TYPE Complete Top imd Cover Wt. Langlh WI.
60 10 35
80 16 45
90 16 45
110 26 65 135 26 65 145 26 65
Top and Cover Bouom Lang!h WI. Leng1h WI.
13 30 15 21 13 30 19 24 13 30 27 30 18 40 27 30 18 40 34 34
Wt.
21
Bollom Ext,n1ion
Length WI. h•m w,.
15 25 Not
24 35 Required
36 45 ..
36 45 ..
24 35 #60 35 36 45 #60 35
Our Figure 8-122 and 8-127 valve boxes are made 'with integral base which measures 81/.'' diame· ter by 9" high. They are kn01Nn as .. two piece valve boxes··. The base wi/1 cover only the stuffing box of valves 10'' and smaUer. (See iJlustration below). Our ''Maximum and Minimum Trench Depth Sheet"' will give you weights and our suggestions as to the correct lengths for certain trench condi• lions. Drop covers marked "WATER" furnished unless otherwise specified. The "two piece valve box" is not always acceptable. Some users require "three-piece valve boxes·· (See illustrations of our Figure 8-129 ~nd 8-130 valve boxes).
TWO PIECE STYLE THREE PIECE STYLE
8-127 8-122 8-129 8-130
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REVIEWED
ROY F. WESTON, INC.
~O EXCEPTIONS TAKEN
[l EXCEPTIONS TAKEN AS NOTED
0 REVISE AND RESUBMIT
0 REJECTED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for ciaforr.nnce wth project design
concept aml" 1•· , . ., .. ,r, .. '.in~,,:e with standards of
quality e~t.J· · . ..' .·. · . : .. ·,•:. :.:,\:,:ract Documents.
This revi~v. .··· .. ·,: · :, .. , ,· .. ·.v,~ Contractor from
responsibifa,:< · •.· .. ·:':;r,ess of detail and
. dimension, r,:;, . :.::r.Jl from Contract
Document r~q·,;_,, .·:~.:.0 ••• ·,·., .•,.c•~pt as noted and
accepted in writing at t_he t,me of submittal of
Engine:~·"''
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I Nome I ·10.16 l I ""M.,,..u-e""'ll-er""'Ca,,.......I 2" 2-1/2" & 3" MUELLER® A-2360 RESILIENT ' . . REV. 4-99 WEDGE GATE VALVES WITH THD. x THD. ENDS
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□ Catalog number--
A-2360-8 threaded ends
~
□ Sizes--2", 2-1/2", 3"
□ Meets or exceeds all applicable requirements of ANSI/A WW A C509 Standard and is certified to ANSI/NSF 61 .
□ Thread end dimensions comply with ANSI B2.1
□ Iron body with nominal IO mils MUELLER' Pro-GardTh1 Epoxy Fusion Coated interior and exterior surfaces
□ Epoxy coating meets or exceeds all applicable requirements of ANSI/A WWA C550 Standard and is certified to ANSI/NSF 61
□ Iron wedge, symmetrical & fully encapsulated with molded rubber; no exposed iron
□ Non-rising stem (NRS)
□ Triple 0-ring seal stuffing box (2 upper & I lower 0-rings)
□ 2" square wrench nut (optional handwheel available)--open left or open right
□ 2"-3" sizes--250 psig ( 1723 kPa) maximum working pressure, 500 psig (344 7 kPa) static test pressure
□ UL Listed, FM Approved: 200 psig (1379 kPa)--3" size
Options
See pages 10.68 and 10.69 for more information on Resilient Wedge Gate Valve options □ Position indicators □ Stainless steel fasteners: Type 304, Type 316 ' □ ASTM B98-C66 l OD/H04 stem □ Handwheel
'ii Resilient wedge gate valve parts .._,~,,
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Catalog ·1 Description Part No.
G-16 Bonnet Bolts & Nuts
G-41 Stuffmc Box Bolts & Nuts
G-49 Siem O -rim•s IJ\
G-200 Wrench Nut Cap Screw
G-201 S1uffintt Box Seal
G:202 Wrench Nut
G-203 Siem
G-204 Hand Wheel (not shown)
G-205 Stem Nut
G-206 Guide Cao Bearinl!S
G-207 Stuffin!! Box
G-208 An1i-friciion Washers 12)
G-209 Wedge,
Rubber Encansulated
G-210 Bonnet
G-211 Bonnet Gasket
G-212 Bodv
Material
Carbon Steel
Carbon Steel·
Rubber
Carbon Steel
Rubber
Cnst Iron
Bronze
Cast Iron
Bronze
Celcon
Cast iron
Celcon
Cast Iron•
Cast Iron
Rubber
Cast Iron I • F,lly·""""'"'" ia mold,d rubb~ wi,h oo irua o,po<ed
!Material standa_rd
ASTM A307 Grade 8, Zinc Plated
AStM AJ07 Gm.de B, Zinc Pla1ed
ASTM D2000
ASTM A307 Grade B.Zinc Plated
ASTM D2000
ASTM Al26 CL.B
ASTM 8138
ASTM A126 CL.8
ASTMB62
ASTM Al 26 CL.8
ASTM A126 CL.B
ASTM Al26 CL.8
ASTMD2000
ASTM Al26 CL.B
mm I SEE PAGE 10. 73 FOR ORDERING INSTl{UCTIONS
I
A-2360-8
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17UIII~ ·I
2", 2-1/2" & 3" MUELLER® A-2360 RESILIENT IMuellerea.1 WEDGE GATE VALVE DIMENSIONS -THD. x THD. 10.17
REV. 4.99
A
·T.=
HHT-l!!!!lll!lfl-----4--V-----U!l-ll+il---11 NPT
I -ww--
1-,. ----v-------l I Dimensions I Dimension• I Nominal size
2" :i!f :2 1/2" . 13" UA 9.88 i 12.38 12.38 V 5.88 5.S8 6.88 I ~ FF 2.30 I ,_30 J.JO i HH (hex -11cm~~ lhts) 3.88 . 4.25 5.00 ! WW 4.12 4.12 5.ll i : Tums to onen 8 II II ii Wei!!ht• 31 :60 62 '
.
• All <limcnsions an.: in inches. All weights :ire in pounds and llrC approximate.
REVIEWED
ROY F. WESTON, INC.
~O EXCEPTIONS TAKEN.·
□ EXCEPTIONS TAKEN AS NOTED
0 REVISE AND RESUBMIT □ REJECTED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project. design
concept and for compliance with standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detail and
dimension, nor for deviation from Contract
Document requirements, except as noted and
accepted in writing at the time of submittal of
is,,,-~ . Ii b
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REV. 4-99
)Mueller Ca.I 2"-12" MUELLER® A-2360 RESILIENT WEDGE GATE VALVES WITH M.J. x M.J. ENDS
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D Catalog number--
A-2360-20 Mechanical joint ends (with mechanical joint unassembled acccsso.ries) ?' A-2360-23 Mechanical joint ends (less mechanical joint accessories)
A-2360-25 Mechanical joint ends (witlr transition gaskets) )< ~
D Sizes--2", 3", 4", 6", 8", 1011, 1211
o Meets or exceeds all applicable requirements of AN'SI/A WW A C509 Standard and is certified to ANSI/NSF 6 I
o Standard mechanical joint ends comply with ANSI/A WW A Cl 11
o Iron body with nominal IO mils MUELLER:• Pro-Gard"' Fusion Epoxy Coated interior and exterior surfaces • ,
o Epoxv coatirrn: meets or exceeds all applicable requirements of ANS[/A WW'A C550 Standard and is certified to ANSI/NSF 6 I
□ Iron wedge, synm1ctrical & fully encapsulated with molded rubber; no exposed iron ·
D Non-rising stem (NRS)
D Triple 0-ring seal stuffing box (2 upper & I lower 0-rings)
□ 2" square wrench nut (optional handwheel available)--open left or open right
D 2"-12!'.sizcs--250 psig ,( l 723 kPa) maximum working pressure, 500 pS!g (3447 kPa) stalic test pressure
D UL Listed, FM Approved: 200 psig ( 1379 kPa) -3"-12" sizes
Options
See pages 10.68 and 10.69 for more infonnation on Resilient Wedge Gate, Valve options O Position indicators □ Stainless steel fasteners: Type 304, Type 316 D ASTM l398-CG6!00/ll04 stem
Resilient wedge gate valve parts
Catalog '. Description
Part No. 1
G-16 I Bonnet Bolts & \°m5
G-4! !Stuffm, Box Bohs & ~UIS
G-49 ls1em0-rim:s(3l
G-100 I Wrench '.\"u1 Ca Si.:rcw
G-201 ! Stuffinl! Box Si::d
G-202 I \\"rench 1'.'ut
G-103 IS1em
G-104 'Hand Wheel not shown)
G-205 !Stem Nut
Carbon Steel
C:1rbon Steel
Rubber
Carbon Steel
Rubber
Cast Iron
Bronze
Cast Iron
Dronze
□ Handwheel
I Material standard
ASTM A307 Grade B, Zinc Pla1ed
ASTM A307 Grade B Zinc Plated
ASTM D2000
ASTM A307 Grade B Zinc Plated
ASTM D2000
ASTM At 26 CL.B
ASTM BtJS
ASTM Al26 CL.8
ASTM 862 G-106 Guide Ca Bearim:s Cclcon
G-207 Stuffinc Box C:ist iron l ~==---t="'----+----------1
ASTM Al 26 CL.B G-203 Anti-friction Washers 12) 11Cclcon
Cast Iron• ASTM Al26 CL.B G-209 /\\'educ:,
Rub6'er Enca sul:11cJ 1 · G-210 ••!Bonnet :Cast Iron ASTM Al26 CL.B G-211 ••, Bonnet O-rinl! I Rubber ASTM D2000
G-212 .. I Bodv I Cast Iron ASTM A!26 CL.B
I
A-2360-20
M.J. accessories
shipped unassembled
_.,, G•18 ---,,,.~, C..211"
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2"-12" MUELLER® A-2360 RESILIENT WEDGE GATE VALVE DIMENSIONS· M.J. x M.J. ENDS
0
I
Dimensions
Dimension* Nominal size ~
2" 13" 4" 16" A 9,88 12.38 14.19 18.00 K 8.50 9.00 10.00 I 1.50 L 2.50 2.50 2,50 2.50 M 2.75 4.06 4.90 7.00 N 4.62 7.50 9.12 I l.l 2 0 tnumber and si11: olho!cs) 4 7/8 4 -7/8 4 -7/8 6 7/S DD 3.50 4.00 5.00 6.50 FF 2.30 3.30 4.30 6,30 00 t bolt circle dia:--.11:ccr) 5.00 6.19 7.50 9.50 Tums 10 onen 8 II 14 20.5 Wei!!ht• 40 83 120 186
• All dimensions nrc i:1 ·u.~hcs. All weights include accessories and are in npproxirmne poW1ds.
(Mueller Ca.I 10.9
REV. 4.99
A
"' ,1
IB" I 1 O" I 12" I
21.50 25.50 I 28.62 I
12.50 14.75 14.88 I 2.50 2.50 2.50 l 9.15 11.20 13.30 ' 13.37 15.62 17.SS
6 7/8 8 i/8 8 -7/8
7.50 9.75 9.88 &JO 10.30 12.J0 l I 1.75 I 14,on 16.25
26.5 33 38.5 i 280 405 1540
"
REVIEWED
ROY F. WESTON, INC.
)s:{No EXCEPTIONS TAKEN
0 EXCEPTIONS TAKEN AS NOTED
0 REVISE AND RESUBMIT
0 REJECTED -DOES NOT COMPLY
WITH l'i:1.0JECT REQUIREMENTS
Reviewed f<)! ·:.,o-:", ... r,•:,;1ce wth project design
. concept rc;:r.' ·.-.·.---.,,_,:;,,;;cc with standards of
qualityesta~'.: .. -: ·· · ·._, .. _ .. _Contract Documents.
This revie1•.-,;<·_. :_ . · · , . .-,,,."" Contractor from
responsibilifrcs • .-·· ::• .. • ,· .. ,;,·,1c5S of detail and
dimension, not l,;;· c,::;·ia!.i'1n from Contract
Document reqt,i~emwts, except as noted and
accepted in writing at the time of submittal of
Engineefi ~
By 1. ~4 ~ ____ 0----.L,7/tµ...L'lµ..IQJ..-I
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REV. 4.99
I Mueller Ca.I 2"-12" MUELLER® T-2360 RESILIENT WEDGE TAPPING VALVES· M.J. x FL. ENDS
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□ Catalog nurnbcr-
T-2360-16 mechanical joint x flanged ends (with mechanical joint unassembled accessories)
,,< T-2360-19 mechanical joint x flanged ends (less mechanical joint accessories) ,,.
D Sizes-2", 3". 4", 6", 8", IO". 1211
□ Meers or exceeds all applicable requirements of ANSI/A\VWA C509 Standard, certified to ANSI/NSF 61 standard, listed by Underwriters Laboratories Inc. and ULC, appro\'cd by Factory Mutual Corp. ,
□ Inlet flange complies with ANSI BI 6.1, class 125 drilling and with MSS SP-60.
Mechanical joint outlet complies with ANSUAWWA Cl 11 Standard. □
□ Iron body with nominal IO mils MUELLER® Pro-Gard™ Epoxy Fusion Coated interior and exterior surt"a.ces. '
□ Epoxy coating meets or exceeds all applicable requirements of ANSI/A\VWA C550 Standard and is certified to NSF 61.
□
□
□
□
□
Iron wedge, symmetrical & fully encapsulated with molded rubber; no exposed iron.
Non-rising stem (NRS).
Triple O-ring seal stuffing box (2 upper & l lower O-ring).
2" square wrench nut ( optional handwhcel available)--open left or open right.
2"-12" sizes--250 psig (1723 kPa) maximum working pressure, 500 psig (3447 kPa) static test pressure
Options
See pages 10.68 and 10.69 for more information on Resilient Wedge Gate Valve options
□ Position indicators
ASTM B98-C66100/H04 stem
Resilient wedge gate valve parts
Catalog I Description
Part No. I Material
G-16 Bonlict Bohs,,;: ~u1s icarbon Stec!
G-41 S1uffinl! Box Rnhs ,\.'. ~uts I Carbon Steel
G-49 Stem O -rinl!s ~J) \ Rubber
G-79 Inlet flnnj.\e l!>1skc1 I Composition
G-80 Inlet fhlllAC bolts n.nd nuts I Steel
G-200 Wrench Nut C.1) Screw ) Cnrbon S1eel
G-201 Stuffinl! Box Sl'al I Rubber
G-202 Wrench Nut / C:ist Iron
G-203 Stem I Bronze
G-204 Hand Wheel (nlll shown) !cas[ Iron
G·205 Stem Nut \ Bronze
G-206 Guide Cnp Bc:irin~s ]Celcon
G-207 Stuffin!! Box ! Cast iroli
G-208 , Ami-friction \\':1sh..:rs ! 1l \celcon
G-209 j Wedge, \ Rubber Encnnsulated ! Cast Iron•
G-210,.. Bonnet : Cnst Iron
G·21 l,.. , Bonnet G:iskct '. Rubber
□
□
Stainless steel fasteners: Type 304, Type 3 I 6
Hand wheel
I Material standard_ i
' ASTM AJ07 Grade 8 Zinc Plated
ASTM AJ07 Grade B. Zinc Plated'
ASTM D2000
ASTM A307 Grode B, Zinc Plated
ASTM 02000
ASTMA!26CL.B
ASTM 8138
ASTM A!26 CL.8
ASTM 862
G-79
ASTM Al26CL.8
I
ASTM A 126 CL.8
ASTM A!26 CL.8
ASTM 02000
G-212,.. i Bodv : Cnst Iron ASTM Al26 CL.B
• • Fully encapsula1ed in molded ru~c~r ,111r. na ,rJn exposed . •• Previous to 1'!!99 these parts on ~-.12· ·.~1,~s 11ere_ designed 1'.i1h a gasket instead of an O-ring and wilh an extra set of boJI +ioles. Confirm the type ~f sa~I 'M~en oroenng a replacement gasket or O-llng. · I:~ P~~~-i2.2;s~,,~~;'~'~RDERING INSTRUCTIONS
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T-2360-16
M.J. accessories
shipped unassembled
,;.,,"' G·ZOO
_..., ........ ;,/ G·210 .. -
--_,,,,.., C·2CS
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Mo2r'.12'J MUELLER® T-2360 RESILIENT WEDGE GATE
TAPPING VALVE DIMENSIONS· M.J. x FL. ENDS
(Mueller Ca.I 12.15
REV. 4-99
Dimensions
.
Dimension• !Nominal size ~ 12" 13" 14" 16" is" I 10" 112" A 9.88 12.38 14.19 18.00 21.50 25.50 128.62 C 6.00 7.50 9.00 !LOO IJ.50 16.00 I 19.oo D 3.00 4.00 5.00 7.00 9.00 11.00 D.00 E 0.16 0.18 . 0.18 0.25 0.25 0.25 0.25 F 4.-16 4.75 6.24 ' 6.75 7.50 8.44 8.26 J 2.50 3.96 4.80 6.90 9.05 11.10 13.20 K 6.25 7.50 9.12 11.12 13.38 15.68 17.94 0 {number nnd size of holes) 4-3/4" 4--J/4" 8-3/4" 8-7/8" 8-,-7/8" 12-1" 12-1" FF (opening through v::ilve) 2.30 3.30 4.30 6.30 8.30 10.30 12.30 yy 8.55 8.99 11.9 I 13.00 14.75 15.80 16.26 FFF {number rind size of holes) 4-3/4" 4--3/4" 4--7/8" 6-7/8" 6-7/8" 8-7/8" 8-•7/8" Tums to open is 11 14 ' 20.5 26.5 33 38.5 Weight• \44 88 115 !80 279 402 565
'" All dimensions are in inches. All weights include ncc1:ssorics and nre in approximate pounds.
SEE PA.GE 12.25 FOR ORDERING INSTRUCTIONS
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REVIEWED
ROY F. WESTON, INC.
~OEXCEPTIONSTAKEN
D EXCEPTIONS TAKEN AS NOTED
0 REVISE AND RESUBMIT
0 REJECTED -DOES NOT COMPLY ·
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design
· concept and for compliance with standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detail and
dimension, nor for deviation from Contract
Document requirements, except as note-;! and
accepted in writing at the time of submittal of Eogio~¥ i ., g,_ ni, -7Jj{o I
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12.2
Rev. 4·01
!Mueller Ca.) MECHANICAL JOINT TAPPING SLEEVE FOR CENTRIFUGAL C.I., D.I., & PVC PIPE
0 Catalog number--
ff.615 Mechanical Joint Tapping Sleeve
0 Sizes--4''<!4" main and outlet (see chart below for available size combinations)
0 Outlet flange dimensions and drilling comply with ANSI B 16.l, class 125 and with MSS SP-60.
0 Certified to ANSI/NSF 61.
0 Iron body with 3/4" NPT test plug.
0 4"-12" sizes--250 psig (1723 kPa) maximum working press~re.
0 14". 24" sizes--200 psig (1379 kPa) maximum working pressure.
Tapping Sleeve pipe information
Nominal 0.D. range of sleeve Class and type of pipe size of main Inch mm
H-615
4.74"-Ulfi" 120.5-123.3 CnM iron dnsse.\ 100, 150, 200 nnd A -nil classes ductile iron -cast iron O.D. PVC plastic pipe classes 150 and 200 _, . -. · .
4·
4.87"-5.32 123.8-135.0 Casi iron classes B, C, and D -A-C classes 100 and 150
6.84"-6.96" 173.8-176.7 Cast iron dnsses l00, 150,200, o.nd A -all clnsscs ductile iron -caM iron O.D. PVC plastic pipe 6" classes 150 and 200
6.97"-7.40" 177.1-187.9 Casi iron classes B, C, ond D -A-C closses I 00 nnd 150
R.99"-9.11~ 228.4-231.3 Cos1 iron cl:mes 100, 150,200, A and B -all clo.~ses ductile iron -cost iron O.D. PVC plns1ic pipe s· classes 150 nnd 200
9.12"-9.62" 231,7-244.2 Casi iron climes B, C, o.nd D -A-C closses JOO and 150
10" II .04 .. -11.16" 280.5-283.4 Cost iron classes 150,200,250, A ond B -nll classes duclile iron -co.st iron O.D. PVC plasric pipe classes 150 and '.WO .. · 1::r 13.l4H-13.26" 333.9-336.7 Cnsl iron dnsses 150,200, 250,A nnd B-a!! dosse., ductile iron -co.SI iron O.D. PVC plos1ic pipe cl n_~ses 150 :ind 200 14" 15 .22" -15.35" 386.7-389.8 Cns1 iron classes 50, JOO. 150, 200, 250, A and B. nil cl:isses ductile iron 16" 17.32"-17.45" 440.0-4-13, l Cost iron c!ns.~es 50, IO0. 150,200,250, A 11nd B -nil classes ductile iron I 8" 19.42"-19,55" 493.4-496.5 Casi iron classes 50, JOO. 150, 200, 250. A and B -:ill cl11sses ductile iron 20" 21 .52" -21.65" 5➔6.7-549,8 Cn.,t iron c!os.~es 50. JOO, 150,200,250, A nnd B-nil classes ductile iron 24" 25 .72" -25.85" 653.4-~56.5 Casi iron cla\ses 50, l00, 150, 200, 250, A and B -nil cln.~ses ductile iron
Sizes available
Nominal Outlet size size of . ;(; main 4" 6" 8" 1011 1211 1411 1611 18" 20" 4" X . . . . . . o·· X X . . . . . , .. X X X . . . 10" X X X X . . . . 12" X X X X X . . . 14" . X X X X X . . . 16" X X X X X X X . . IR" X X X X X . X X 20" X X X X X X X X X 24" X X X X X X X X X
End Gasket part numbers
195824
195653
195825
195654
195826
195655
194680
194638
195117
195128
195200
195129
195130
24"
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X
REVIEWED
ROY F. WESTON, INC.
&OEXCEPTIONSTAKEN
□ EXCEPTIONS TAKEN As NOTED
□ REVISE AND RESUBMIT
□ REJECfED .:_ DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for confo;mance wth project design
concept and for compliance with standards of
qualit{estab!i:,kd in the Contract Documents.
This review ,hsll ;1ot relieve Contractor from
· responsibiJitii:s :,,-r .:crrectness of detail and
dimension, w·,, for ,:kviation from Contract
Document rt:,; ,,i-, ;;., ,1ents, except as noted and
accepted in writing a: the time of submittal of
Enginee~. M\J '
By 1',1/M :W\~o 7jtcdo I
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Ring-Tiie® PVC Pressur-a
Pipe per ASTM 0224"1
J.Rl\NS-STATE CONS"fF:UCTION C ..
,,Af/APPHO'!ED 0 APPHOVED f•.S NOTED
[7 NOT M'PROV[D
I Rlng-7lle PVC
Prsssura ?ips
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Description
Pipe conforms to ASTM 2241 for standard dimension ratios: 125 psi pipe -SOR 32.5; 160 psi pipe -SOR 26; 200 psi pipe -SDR 21. PVC compounds used in the extrusion of this pipe meets or exceeds the requirements of the material se·ction of ASTM D 2241. Rubber rings conform to ASTM r J 77. Joint design tested lo the requirements of AST'.I D 3139.
Appllcallons
Aural water, agrici..;itural and turf irrigation pipelines. The pressure rating oi :he pipe-125 psi, 160 psi. or 200 psi-indicates the !7',aximum allowable sustained pressure I . with a_ long-term 2 to 1 safety factor.
Meet Accepted S!:n::arcs
NSF Standard 61
I J-M Ring-Tits PVC.~: ::as 3.re manufactured in comp!iance 'Nith AS}~·1 D224~ ,':~ :;2ss:..:r2 rnted pipes.
I
Designed for Installed-Cost Savings·
· Save In handling costs. Most sizes can be handled .manually, so them is no need for costly installation equip' . ment. Use the backhoe for excavating and backfilling only. Dig more trench. lay pipe faster, save more in costs per foot Installed. ·
:Easy lnstallatlor.. Products should be installed in accor-dance with J-M Publication TR 533A, Ring-Tite'' Installa-tion Guide.
Save on fittings and thrust blocks. J-M Ring-Tile PVC pipe can be curved as shown in the table to eliminate many corners that would require elbows and bends. The costs ol these ilems and labor are saved.
Min. Radfl ol Curvature
Size (in)
1½
,\(2
21/2
3·
4
6
8
·to
12
Test
Radius (feel)
38
50
63
75
100
150
200
250
300
Long Term Pressure Test ,ODD hours
Quick Term Burst Test
Acetone Immersion Test
A measure at proper fluxing
antj precise temperature
control
Flattening Test
Tests extrusion quality
and ductility under slow
loading conditions.
NOTE: Offsets were calcu•
lated assuming no deflec-
tion at the joint. The bent
pipe is also assumed to
form a true arc, i.e., pipe is
curved uniformly through-
out its length.
· ASTM D2241
125 psi 160 psi k200 psi
260 340 420
400 500 630
20 min. 20 min. 20 min.
60% in 600/o in. 60% in 2-5 min. 2-5 min. 2-5 min.
REVIEWED
ROY F. WESTON, INC.
Jl?l'NO EXCEPTIONS TAKEN ·a i3xcErnoNs TAKENAs NOTED
0 REVISE AND RESUBMIT
□ REJECTED -DOES NOT COMPLY
Willi PROJECT REQUIREMENTS
Reviewed for conformance wth project design
concept and fc r compliance with standards of
quality established in the Contract Documents.
This review s'rnil nc-t relieve Contractor from
responsibilitieo hr ~cJr,estness of detail and
dimension, nu; ror. deviation from Contract
Document.reqil!!'imr:.nls, except as noted and
accepted in writing ilt the time of submittal of
Engineer ii/I
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SPEClFlCATIONS DATA
PRODUCT DESCRIPTION
· • Diamond (C900) PVC Pipe (4" through 12") is
made of 12454 compound per ASTM D1784, in
. : · accordance with the dimensionai, chemical, and
physical requirements of AWWA C900.
_i, Diamond (C900) PVC Pipe bears the mark of NSF,
International (NSF), the listing of Underwriters :1 Laboratory, Inc. (UL), and (DR14 & DR18) bears
, the listing of Factory Mutual (FM). ·
'I Diamond (C900) PVC Pipe utilizes a gasket, per
J. ASTM F4 77, to seal the integral bell socket to the
. ·· spigot of the next joint (w,hich conforms to the
requirements of ASTM D3139.) Each male end is I beveled to facilitate joint assembly, and the spigot
'"· is reference marked in insure proper insertion
depth. Diamond furnished lubricant is to be used I in the joining process.
I
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!:'~~! . C900 PVC Water Pipe -m:,_~ !':,,":: = )I:;: 1:2-.
1~i .Diamond C900 PVC Water Pipe shall be =~ ·~= I made ot compounds conforming to 1-:1-.,•, · -_&~: ASTM D1784 with a cell classification of ~.),ti)
l '-;t~j · 12454. Diamond CS00 shall meet all ;~)
• ""¼ the dimensional, chemical, and physical t.:::;~ ~f~l . . requirements as outlined in AWWA CSOO .::tf~J
,, ;~ ·-· -and will be supplied in 20 foot laying ~
t:'""~ lengths. Pipe shall be manufactured .... ·i;:i: 1·§1~i from-National Sanitation Foundation §}:'3
-~ . (NSF) approved compounds. ~~"' -~~=====c=;====;=========~~.~ .,~{f:Si:{~~::R~=:S~;~_;;:l'-~f ~I'.S~S~!
7
PROPERTIES OF PVC 12454
PHYSiCAL PROPERTiE5
Property
Specific Gravity
Tensile Strength, psi
Tensile Modulus, psi
IZOO Impact Strength,
ft.,•lb./in.
ASTM
Test
D792
D638
D638
D256
Minimum
1.40
7,000
400,000
.65
CHEi\JllCAL RESlSTANCE
ASTM Test
93.0% Sulfuric Acid, D 543
.14 Days Flotation ·at
· 55 + or -2° C
Change in Weight, %
Change in Flex Strength, %
ASTM Oil No. 3, 30 Day
'Immersion at 23° C
Change in Weight, %
-0.1 + 5.0
-25.0 to + 5.0
-1.0 to 1.0
Apprcv1!<l
·~ Diamond ~ Plastics 1Ci V Corporation Pipe & So..c,'<;ei
Dimsnsion·s
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Marks
Step / lnsart ◄---C--__,.)
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l minal
'. Size
-" 1100) ; " 11501
~ "1200) j" (250)
·• "(300)
,;,:.:,;.
A
Pipe
0.0.
4.800 1121 .9)
6.900 1175.3)
9.050 1229.9)
11.100 1281 .9)
13.200 1335.3)
B
Soci<et
Max. 0.D.
6.5
9.25
11. 75
.' 14.25
16. 75
·c
Socket
Length
6
6 1 /2
7
7 1/2
8
Rear lip
j
Main lip
Insert
Mark
5
6
6 1 /2
7
7 1 /2
• C900 Minimum Wall
DR-14 ~DR-18 DR-25
.343 (8. 71) .267 16. 78)
.493 (12.52) .383 (9.73)
.646 (16.41) .503 (12.78)
.793 (20.14) .617115.67)
.943 (23.95) ·.733 (18.62)
Pipe material and design:
.192 (4.88)
:276 (7.01)
.362 19.19)
.444 (11.28)
.528 113.41)
The Rieber seal is an integral sealing ring that is applied by the pipe manufacturer using a special patented socket-forming technique. A cross-sectional view of the pipe soc\~et is shown in the figure below.
. .
~>~':-~,'::
REVIEWED
ROY F. WESTON, INC.
~O EXCEPTIONS TAKE~
□ EXCEPTIONS TAKEN AS NOTED
□ REVISE AND RESUBMIT
□ REJECTED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design
concept and for compliance with standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detail and
dimension, nor for deviation from Contrnct
Document requirements, except as noted aad
accepted in writing at the time of submittal of
&onoo~ ~ U By 1,IM: ·. 4i,Jl 1
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JRANS-STATE CONSTRUCTION C .-iiY APPROVED .
0 APPROVED AS NOTED
0 NOT APPROVED
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~ Materials
Slue Bn.ite piqe meets tr.e r=c;uiiaments cf t~a F.r:-:er:c~.-. \Natsr Wcrks fl..ssuc!atlon water ciistribui"icn stsncic.r::! A'vVvVA C800. The FVC Ce!! c:assification·Js 1'.245.!E as defined under ASTM 01784. Prsss...:rs rc:tir.cs 2nd Ci;--;;.ensicn ratios are as follows: -
Mex. Werking The specification •,vith whic;i J-~'1 ~1lanufacturing's Elue 5r!Jts is ma~ufac::.::rad c'Gs;gnates ger.e:-a/ rec;uirer..ents for .
Pir2e c:ass DR
Class 100 25
Pre~sure @l.~_:_f_
100 psi unpl2stic:zed polyviny! chloride (P\/C) pl2stic ci2ss water pipe with integr2J bell anC spigot jcints for the cc-nveyance of water c:nd other rluids.
Class 150 18
Class 200 14
150 pSi
200 psi
1~ Applicable Specific:atlons
... _. Pipe
Blue Brute pipe is suitable for use as pressure conduit. The be!! consists of an integral wail section with a factory inst2iled, elastomeric ring that allows for expansion and contraction at each joint.
All classes of Blue Brute pressure· pipe are UL listed for · water mains as well as being tested and certified to ANSI/NSF Standard 61. .
'··~ C:::st.!:ari. o.o~· · · ·. . . · .. ·. : _. · :~ Jc int Des ion
·Blue ~rnte's jOint design meets P..STivl 03139 joint qualification performance testing requirements, with which the e!astomeric ring is manufactured in compiiance With ASlivl F477.
· Availabie in 4_":,6'.',8", 1 O" and 12" Sizes, Blue Brute can be connected direct/v lnto·cast iron and ductile iron fittincs .wiihout ,ada_pters·or complicated procedures, "_
' . ' ·~ Standard Layin'9' Length$ St5ndard·layirig lengths shall be 20 feet (±1 ") for ail.sizes . .,::1 r.;,diO Testing
E.ac:-i section of pipe is tested to four times the pressure class for 2 minimum of 5 seconds cs a matter of routine ,a Purple R2c\2im and Green se\ver qua!lty c::::ntrc! testing. · J-M also manufactures AWWA C-900 pipe in Purple colcr specifically for rec!aimed water systems, and Green for sewer forced main applications. These pipe are made and tested to the same requireme_nts as our standard product, ~xcept that the pigment used is purple or grean. Thesa producis will not be markad with the UL, FM or NSF listing marks. Additionally, the purple pipe will be marked : " Reclaimed Water ... Do Not Drink'' :.· . -~ ·!_, 1mens1or.s
I 1 -· • 1 Outside II Nern. Inside If Wall Thicl·mess II Apprcx. \/-It. No~ir,a, t"ipe s,z~ I . (,., 1 _ . ·Dtarneter uO. Diameter ( ID·) Min. ( T) ( Lbs.~Ft) / \CL'sSS 100 ( PR 25 )
\ 4 11 4.ao 11 4.39 11 0.192 ii 1.9 I 6 1 6.9o 11 6.30 11 0.215 11 3.9 1 8 II 9.05 I\ 8.28 II 0.362 JI 6.7 I ir===:';:1 o;====;:=1===1~1=;;.170 =c=;li:= ==170.'='16c==\l!l===o.=44=4==;l:=I =1=0=.1==:11 1 12 11 13.20 11 12.08 11 o.528 11 14.4 1 jCL,',SS 150 ( DR 18 ) I 4 I 4.8o 11 4.23 11 0.26, 11 2.6 1 '.a====a6===ala===o==··g=o==="lli===6;=;.osii9===\lll===iio~.3~83ii==;l~I ==is~.3ii,==;II 11 ~ a 11 9.os 11 7.98 I/ o.so3 11 9.2 I 1:======1=ao===a1:===171.71 o;;==:11:= ==_~a."'79==:1;:=I ==0""_5a=1"'7===;1i!==1=as3=a_g==;1
1 12 11 13.20 11 11.e5 · 11 o.733 11 1e.,. 1
/ 4 I 4.8o 11 4.01 11 o.343 11 3.2 1 6 1 6.9o 11 s.86 11 □.493 11 6.7 1, 8 1 9.os 11 7.68 11 o.646 11 11.6 1i 10 1 11.10 11 9.42 ii o.793 11 11.6 1 12 11 13.20 ii 11.20 II· a.943 11 2s., 1 Notes.
A. Outs,ce Diameter (OD) average dimensions conform to Cast Iran OD (C.i.O.D.l. 5. All Cirnensions art: in inches unless spec·1fied otherwise. ·. C. PmCuct information effecti'1e as cf 7/00. SubjeCt to revision at 2.nY ti.me. :=·.ef~rer:ce Specificatfons: .· ~::;~~fit;-;~,-;,~~91~0 : " P\/C :=::-s:::sc.::e ?:;;e and Fabr:c3ted Fitting, .l"-·12", For '/'/atet
·. :: -;-· .. ,
REVIEWED
ROY F. WESTON, INC.
21:'No EXCEPTIONS TAKEN .
□ EXCEPTIONS TAKEN AS NOTED
0 REVISE AND RESUBMIT
□ REJECTED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design
concept and for compliance with standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detail and
dimension, nor for deviation from Contract
Document requirements, except as noted and
~c~;[nt=~Q:J.mg~ of submi;al of
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Ouc·Ule Iron Pipe
TYTON JOINT® Pipe
, Thlckness Class Designation
Speciiications
!
Pipe shail be ductile iron manufactured in accordance with the requirements of ANSI/AWWA C151/A21.51.
Push-on joints for such pipe shall be in accordance with ANSI/AV/WA C111/A21.11. Pipe shall be Gr'1ffin or equal. Pipe thickness shall be designed in accordance with ANS!iAWWA C150/A21.50 and shall be based on laying ccndi!ions and internal pressure as specified in the pro_ie-ct plans.
Pipe shall ha1.:e cement mortar lining and seal coating,
where spoiicable, in accordance with ANSI/AWWA C104/A21.4.
Dimensions & Weights
Pipe Barrel
ihic:c Norn.
Size C',;;:,,S,3 Thick.
in. in.
Si 0.25
::".' 0.28
'"' ::..; 0.31
0 c, .. , 0.3--t .... 0.37
'.;G 0.40
~; 0.26
:::2 0.29
4 ;:,1 0.32
5,1 0.35 .... ,).38
... 0.41
.. :;,:~
~ ·, ·'.J.28
.::..-:: ·.~.21 6 .
I . ., u,_;;~
' :;:.: ::.21 ..
'
Norn.
O.D.
in.
3.96
3.96
3.96
3.96
3.96
3.96
4.80
4.80
4.80
4.80
4.80
4.80
6.90
6.90
6.90
0.90
6.90
6.90
G.90
A
-Bell
0.D.
in.
5.48
5.48
5.48
5.48
5.48
5.48
6.52
6.52
6.52
6.52
6.52
6.52
8.66
8.66
8.66
8.66
8.66
8.6G
8.66
B
Bell
Depth
in.
3.00
.3.00
3.00
3.00
3.00
3.00
3.15
3.15
3.15
3.15
3.15
3.15
3.38
3.38
3.38
3.38
3.38
3.38
3.30
X
Dell.
Angle
deg.
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
18 ft.
Wt. Per
Lglh.t
lb.
168
186
204
221
238
254
214
236
258
280
301
321
304
337
370
402
,434
466
' 1--,---·--
9.05
:"L05
9.05
~~.05
-? OS
9.05
9.05
10.02
1497
3.G9 5 I I .431
I0.82 3.69 5 475 8 X 5• 10.02 3.69
t0.02 3.69
5 519
5 562
10.82 3.69 5 605 t0.82 3.69 5 .648
10.82 3.69 5 691
Laying Length
20 ft
y y
Max. Wt.Per Max.
Defl. Lgth.j ·Dell.
in. lb. in.
19
19
19
19
19
19
19
19
19
19
19
19
I
19 I 336 21 I 19 I 372 21
·19 I 409 21 ' 19 ! 445 21
10 ' ..\81 21
516 21
10 551 21
9 .177 21
9 52G 21
9 574 21
9 622 21
9
\
1370 21
9 718 21
NOTE: 10" THAU 24"
9 76.5 21
REVIEWED
ROY F. WESTON, INC.
~O EXCEPTIONS TAKEN
□ EXCEPTIONS TAKEN AS NOTED
0 REVISE AND RESUBMIT
□REJECTED-DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for confcrrnance wth project design
concept and for compliance with standards of
quality establishee in the Contract Documents.
This review shall :10t relieve Contractor from
responsibilities fur correctness of detail and
dimension, nor i,,r deviation frorn Contract
Document requir,;me.nts, except as noted and . ~';ia~~i.~~t ;:o of rubmi;•• of
Byr,"=f"' ~ d 1/i1to 1
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ES-25AUB
Job Name
Job Location
Engineer
Approval
Contractor
Approval
contractor's P.O. No. ____________ _
Representative
Series 25AUB
Regulators*
Water Pressure Reducing Valves
Sizes: ½" to 2" (15 to 50 mm)
With integral strainer
Series 25AUB water pressure reducing valves are suitable for initial · water pressures up to 300 psi (21.09 bar) and can be adjusted from. 25 to 75 psi (172 to 517 kPa) delivery pressure to the system. The standard setting is 50 psi (345 kPa). They are standardly furnished with a bronze body, union threaded female inlet and female threaded! · outlet connection, stainless steel seat and strainer. All parts are easily and quickly serviceable without removing the valve from the line. The built-in by-pass prevents buildup of excessive system pressure caused by thermal expansion.
• A water saving test program concluded that reducing the supply pres-sure from 80 to 50 psi (551 -346 kPa) resulted in a water saving of 30%.
FEATURES
• Union in!et connection
• Integral stainless steel strainer
• Renewable seat module
• Bronze body construction
• Serviceable in line
• Bypass feature controls thermal
expansion pressure
• High temperature resistant reinforced diapgragm for hot water,
SPEC/FICA TIONS
When the supply main pressure exceeds 60 psi (413 kPa), an ap-proved water pressure reducing valve and strainer shall be in-stalled in the water service pipe near its entrance to the building to reduce the water pressure to 50 psi (345 kPa) or lower. Sill cocks and outside wall hydrants may be left on full main pressure at the option or the owner.
For service water systems up to and including 2" (50mm) provi-· sion shall be made to permit the by-pass flow or water around the valve back into the supply main when pressures, due to thermal expansion on the outlet side or the valve, exceed the pressure in the supply main. Pressure reducing valves with built-in by-pass check valves will be acceptable.
Approved valves s.hall comply with ASSE 1003 -Wans No. 25AUB.
wans product specifications in U.S. customary units and metric are . approximate and are provided for reference only. For precise measurements, ._.please contact Watts Technical Service. Watts reserves the right to change or modify product design, construction, specifications, or materials without prior , notice and without incurring any obligation to make such changes and modifications on Watts products previously or subsequen~y sold.
By-pass valve assembly
far 1 ¼" -2" sizes
Integral stainless By-pass for steel strainer w• -1" sizes
A LEADER IN VALVE rECHNDLDGY ~'IWAI ii S'I lW REGULATOR . -s1rico 1874 Watts Industries, Inc.-Water Products Division• Safety & Control Valves
USA: 815 Chest11ut Street, North Andover, MA 01B45-6098 Cana~a: 5..135 Nert/\ Service Road, Burlington, Ontario L7L 5H7 www.wansreg.com
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MATERIALS
Bronze body construction
Renewable stainless steel seat
Stainless steel integral strainer
Reinforced Nordel diaphragm 'I,' -1' (15 -25mm) Reinforced Buna diaphragm 1 W -2· (32 -50mm) Buna-N valve disc
Note: for LP models where application temperatures exceed 160°F (71 °C) but not over 180°F (82°C), Teflon protector should be added to sizes 1¼", -1½', 2" (32. 40, 50mm)
CAPACITY
Sizes:½", ¾11, 111, 11/.•", 1½", 2"
(15, 20, 25, 32, 40, 50mm)
kPa psi
0 0
e c 34 5 ~' I\'
I\
.~ ~ 69 10
'I,
"
.!:
't:I 103 15
·' ,,,._ " '--
I'----~ PRESSURE-TEMPERATURE " u ~ " --Initial Pressure: \. ' " ...._ -2' (50mm)
l/1'(15mm) " ' ,_ "-
" -~ 138 20 "' Suitable For supply pressures up to 300 psi (21.09 _bar) Reduced Pressure: 172 25 I I ¾' (20mm) 1'{25mm) Wl"(32mm) W1"(40mm)
Adjustable reduced pressure range 25-75 psi (1.76-5.27 bar) Standard sening 50 psi (3.52 bar)
Ma~m;~~~~:~~60°F (71°C) 9 @® ~
Meets requirements of ASSE Standard 1003; (ANSI A 112.26.2); CSA Standard B356; Southern Standard Plumbing Code and listed by IAPMD ..
Military Standard MIL-V-181468 Type I.
OPTIONS
Sizes Vz" -2" (15 -50mm)
Suffix:
DU -Threaded femille union inlet and outlet connections G • Gauge tapping
GG -Gauge tapping and 160 psi (11.02 bar) gauge HP. HI-pressure range 75-125 psi (5.27-8.79 bar) LP -Low pressure range of 10-35 psi (69-241 kPa). Set at 30 psi (207 kPa) no-flaw pressure. Max pressure 100 psi (6.9 bar). Max tempernture 160°F (71°C).
S -Solder union inlet x NPT female outlet connections. 5-DU -Solder union inlet and outlet connections.
Sizes 1/2", 3/4", 1" (15, 20, 25mm)
Suffix:
SC• Sealed spring cage for hi-rise applications 23 • for waterworks pit installations. Has sealed spring cage and corrosion resistant adjusting & cage screws. 27 -for 400 psi (27 .6 bar) initial pressure, ¥, (19mm) only.
0 10
0 38
25AUB-DU or
25AUB-S-DU
' 25AUB-GG
20 · 30 _40
76 114 152
50 60
190 228
Flow
DIMENSIONS -WEIGHT
Size (DN) A A,
in. nim in. mm In. mm
'l2 15 5½ 140' 63/i 171
lS v~ 20 5½ 140 6¼ 171 1 25 6 152 71/, 200 11,~ 32 B¼ 222 11 279 1½ 40 9 229 111/s 283 2 50 9¼ 235 12'h 318
ES-25AUB 9911
Dimensions
C
in. mm in.
31/e 98 11/(
3% 98 1¼
4 102 2
5½ 140 2¼
5½ 140 2¼ 6¥, 172 3¼
D . Weight
mm in. mm lbs. kg.
32 2½ 64 3½ 1.6
32 2½ 64 3½ 1.6
50 2½ 64 6½ 3.0
57 2½ 64 10 4.5
57 2½ 64 10 4.5 83 2½ 64 15 6.8
USA: 815 Chestnut Street. ~or!h Mdovtr. MA 018t5-6cge C1~1a1: 5(35 llonh SeMCC: Roaa. 8url1nq1on. On1~110 Lil 5ft7 www.wansreg.tcm
• 9001
CERTIFIED
c wans Regulator C(?., 1997
70 BO 90 100 gpm .
266 304 342 3801pm
Printed in U.S.A'.
REVIEWED
ROY F. WESTON; INC.
/ ' ,,,,,, ,-EJ NO EXCEPTIONS TAKEN
0 EXCEPTIONS TAKEN AS NOTED
□ REVISE AND RESUBMIT
□ REJECfED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design
concept and for compliance with standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detail and
dimension, nor for deviation from Contract
Document requirements, except as noted and
accepted in writing at the time of submittal of
Enginet·. t' fl . t 1· ~7,,::, l' ', l / ,., H. , . \
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_12":x 17" Stcndtird. Rectangu!cr Valve Boxes (cont'd)
--,--
-'--1-5/8"
. >---._ ,,
,1·•· \]/.,,,.
Part# Description
WATER WORKS (CONT'D) .
D1200-0LSGWTRL 12'x17' Overlapping Water Cover D1200-0LSBL 12"x17' Overlapping Water Cover D1200-BDOLSBL 12"x17" Bolt Down Overlapping Water Cover D1200-BDSBL 1Z'x17' Boll Down Overlapping Water Cover D1200-0LLOCBL 12"x17" Overlapping locking Waler Cover D1200-SGWTRL 12"x17" Drop-in Waler Cover D1200-DISBL 12"x17" Drop-in Water Cover D1200P-DIRP 12"x17"x12" Box, Drop-in Reclaimed Cover· 01200-DISGSWR 12"x17" Box, Drop-in Sewer Cover 01200-DISBSWR 12"x17" Box,.Drop-in Sewer Cover 01200-0LRB 12"x17"x12" Box, Overlapping Meler Reader
Cover
D1200-DUOLRB 12"x17"x12" Dual Box, Overlapping Meler
D1200-DIRG
D1200-DIRB
D600E-DIRB
Recider Cover
12"x1rx12" Box, Drop-in Meter Reader Cover 12"x1rx12" Box, Drop-in Meter Reader Cover 12"x17"x6" Extension, Drop-iri
Meter Reader-Cover . · · D1200-BDDIRB 12"x17''x12" Box, Bolt-down Drop-in
Mel~r, Reader Cover D1200-DUDIRB 12"x17"x12" Dual Box, Drop-in Meler Reader
Cover •I \·~---T
6-314" I
D1200-CI
D1200-0LCIR
12"x17"x12" Box, Cast Iron Cover
12"x1rx12" Box, Overlapping Cover with
Cast Iron Meter Reader
12"x17"x12" Box, Drop-in CoVer with
Cast lion Meter Reader 12"x17"x6" Extension, Drop-in Cover
with Cast Iron Meler Reader
1
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: ! f\/ ~ D1200-DICIR
~J ~,\\i 0600E·DICIR .~,/.,,~ \ Y--<
D600PS-DICIR 12''x17"x6" Extension, Drop-in Caver ~ with Cast Iron Meter Reader ,. 11~ :'.I O1200-DUOJCJR · 12"x17"x12" Dual-Box, Drop-in Cover with <' · w'57., Cast Iron Meter Reader :,,:I D1200-CICIR 12"x17''x12" Box, Casi Iron Cover with
Cast Iron Meter Reader "'" T. 01200-BDSBSRL 12"x17" Bolt Down Overlapping Sewer Cover D1200-DISBSWRL 12"x17" Drop-in 'sewer Cover
'.
·I· 2,, 1
1
D1200-DISGSWRL 12"x17" Drop-in Sewer Cover D1200-0LRBL 12"x17" Overlapping Meter Reader Cover ·.,., I D1200-BDRBL· 1Z'x17" Boll Down Meler Reader Cover . i )-D1200-0LCIRL 12"x17" Overlapping Cover with Cast Iron .• _J_ .,, Meter Reader D1200-DIRBL . 12"x17" Drop-in Meter Reader Cover " O1200-DICIRL 12"x17" Drop-in Cover with Cast Iron · 1 s ""<:',,;,§;~ 1,"-· Meter Reader I' '.J,,.,. '--...,_ __ . ,,; D1200-CIL 12"x17" Cast Iron Cover ' D1200-CICIRL 12"x17" Casi Iron Cover with Casi Iron ., . Meter Reader 3x4" Pipe Slot
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ACCESSORIES
D1200-B/O
D600E-EXT
. D1200·BDB/0
D600E·BDEXT
D1200-DUB/0
. D1200G-B/0
D1200P-B/0
12nx17"x12" Box
12"x17" Extension
12"xff'x12n Bolt Down Box
12"x17" Extension with Bolt Device
12"x17"x12" Dual Box
12"x17"x12" Box
12"x17"x12" Box
Color Pit. Qty, Specifications
Green 216 DFW #D1200, 12"x17"x12" Black 216 Rectangular polyolefin Black 216 valve box cind standard Black 216 drop-in cover with UV Black 216 inhibitor. Optional
Green 216 overlapping lip cover, Black 216 Jocking cover, bolt down Purple/Purple 72 cover and plastic or cast Black/Green 72 iron reader cover and Black/Black ·72 6" extensirin available.
_Black/Black 72 DFW# D600E, 12"x17"x6"
Rectangular polyolefin
Black/Black 72 valve box and standard . Black/Green 72 drop-in cover with UV Black/Black 72 inhibitor". Optional
overlapping llp cover, Black/Black 42 locking cover, bolt down
cover and plastic or cast Black/Black 72 · iron reader cover.
' Black/Black. 72
· Black/Black 72
Black/Black 72
Black/Black 72
Black/Black 42
Black/Black 42
Black/Black 72
Black/Black 72
Black 216
Black 216.
Green 216
Black 216
Black 216
Black 216
Black 216
Black 216
Black 216
Black 216
Black 72
Black 42
Black 72
Black 42
Black 72
Green · 72
Purple 72
I.HANS-STATE CONSTf{UCTION
,/ APPROVED
0 APPROVED AS NOTED
O NOT APPROVED
I =--=-=====-=-==""'"""""""""'""""'"""_"""...,.,..""'"'""""""'""'=====~i: For customer service, please send your fax to: 1-800-726-1998 or call 1 ·800•726-1994.
co
REVIEWED
ROY F. WESTON, INC.
hN-o EXCEPTIONS TAKEN
□ EXCEPTIONS TAKEN AS NOTED
□ REVISE AND RESUBMIT
□ REJECTED-DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design
concept and for compliance with standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detai] an~ ·
dimension, nor for deviation from Contract
Document requirements, except as noted and
accepted in writing at the time of submittal of
Engineer. . ·
,.~ .\, { 1 v;1 1 1
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Ford s~::1.11 var,,e Curb Stops
Ba!I Valves ·with Femalt! Iron Pipe Threads
I
Options Available ___ _
...
Female Iron Pipe Thrc;idn Bath Ende
"''CA'rii:do:·: •. • <!'la·,V.u.vi;s.l. ".·:ON&,, I., C)THEAi ·1·::A?P~bx:·:, ,. AP :so,.·, :•::.' "'t;.:t" "::'j"I-.••~•~ .,,:,,I,'''• ' .,•, , • .: ••, •. I I_ :i: .. : .,. ·•• •• ' ' \' '' ' . • .· ' ' •" • ,; tl-w~BEB_!•:,•:.:.."::: ... t -:~·61ic· -~-:.! 1:_ENl:l•,•i-.l 1 -:-·END\ .:.1 · L~GTi-1 ·• ~-Wi" La~:-:·
-611-333 3/4' I 3/4' . 31" I 3•316" : .9
e11-343 s14• I 1 · 314• · r· :,.sI15· : .c
611-344 31•" 1• 1· I 3.11116' ! .1
B~ 11-344-4.5 3/4" I 1 ° 1' ,i:'112• '·,3
-l(-"Bii-444 1 ,., 1 1· ;;.r3i10· ____ .~
611-455 ! 1' I 1-1!4" I .1-114" 4-7/16' :.1
B11-ii& 1-1/11" 1 114' ;:iit.•, l J.-11.11"· .. 1 -. '.
611-566
-Bll-600 ''"if\';a77
•• B11-777
B11•788'
1-1/4" 1· 1-.12" I ,-~/21' 4-112'' ~
1-1/2'' ! 1-112' I 1-1/2' 4-3/4.'
i-1/2" 2· ! 2'. 5-1/4"
2•·-2· I 2-• 5.3;9•
I z· Z-I12'
'
2-lr.t:" C}-1/6"
.. Female Iron Pipe Threads Both Ends
Minneapolis Pattern Valve
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1.1
1~• ··.-cA:i-ALW-.-=-1-•·~.' ,''. 't· )/ ACWi•j: · :-~Jt:)j.re,:-~.~"' 0.THEil'-' :,.'J··-~ :-w,•Ro;,i,':· ·. j;,'i;;:,Ap ~:-.:.'i , .... .., ... , .... ~:1';1_;$, %:i;· •"'Vl' ·',. • ..-' i-.~· .. , "i'JJi,:~'E( ..... ,~ilr+ ·:•I :•.,,n', ... ,:-.;~~ .. ;.,.:.:Nll BER • .,;·oc.:.r.; .';t-.,S~,, ::~EN~.,,, ... ND,:,':"_.,.,·,J,2£NG1lrl\,.;,, . 1
•AQ:C. ~~:;. ··11,t ... :•
~ E11-33SM 3/4" I 314" I
Bl 1◄44M 1· ' , . ,_,
B11-455M .111 ' 1-H4•
Fl11-.FiiK.,liM 1~1/.L" • 1-1/4"
B11·666M 1-;12· I 1-1,'2"
il1H7GM 1-1/2' 2' f· B11~nM 1-1/2' 2· -B11-7'7TM ' 2' 2· I
B11-7G5M --1 z• 2-112· I
314"
1"
1-1/4'
h114'
1•1/2"
1-112··
2·
2'
2-1/£'
3-3/8" I ·-... ,-3-13/HI" · 1-~-" 4-7/16'' .
4-3/4" " -I .
' -
5-3/6' -i . --I -
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1.4 rr--~
B11·666SWM 1-1/2" 1-1/2" 1-1.'2' 4-314' ,-_4 __ •
_i;=-1~1:..•'~'~'~o~w~,.,'-'--'"'-. _.,_-=-2·_ .,__=-2·_· ~-=-s-""'a"'e_· ~--0:0-
JRANS-STATE CONSTRUCTION
. ,ttJI APPROVED
□ APPROVED r.s NOTED
CJ NOT APPROV.~D .=----
"Indicates avallabl,, with Stop end wa,.te Feature. Add "SW"tc.he end of the Cataiog N,,,cer. Examole: 611·3333l'/. "t,\..,1)1....) -of-F
Fnr Reclaimed Wates· T@e Head lnurt"A rr into the Cata/cc Number. Example; BRW11-333W. Tee Head sold only witr. Pad1oc:l< w:~g.
Padlock win9s -A11 1Jal~es are a.va!1able, 1ilh Pad10:::k W1n;;s (except fer !'Jinneapolis Pattern Valve~. Add "W" to catalog Number
Star.oard Tae l-lsad Sr::lps In bodypBr!Tlit 91,• tum only, Full 36D• tee ha..ad rotation ls available. A:ld "R"to Ca!alog N1,:moe~. Exa;1p a: 811-3338.
Curb Box B••~. crnica Number C8•7 fi r 1 ·1/4'. H/2' and 2• Ball Valve Curt Stops Is l.stod in Catala;; Se::tioi GA.
2" Gate Valve Ooeral,lng N~t la avaUable lor 1-1/4', 1-1/2' and 2" Ball "✓alves aad csn be ordered !,om page 37.
L0eic.6aps are ava1:l!:i!e tor ~d~ thru 'L" B 111 Valves and ca., De oraer~o t_f_or., ::,ag_e ~-
Handles atQ ava:abli? tor Sall Valves and :an ba ordared !r:>m page 38.
r..1inn~apolls ?attern Valves are awilablt in a. 'lariely cf sites. For sites other 1han those i:-. a::mve tab!e plazs~ ~ntar.: tl-e ta::to;-: .
G-4
co .
REVIEWED
ROY F. WESTON, INC.
'\./ .
·,EhNO EXCEPTIONS TAKEN
□ EXCEPTIONS TAKEN AS NOTED
□ REVISE AND RESUBMIT
□ REJECTED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design
. concept and for compliance with standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detail and
dimension, rior for deviation from Contract
Document requirements, except as noted and
accepted in writing at the time of submittal of
Enginee~.. . {' / 1 /
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!Mueller Ca.I END CONNECTIONS FOR COPPER METER YOKE~
WITH MULTI-PURPOSE ENDS REV. 4-99
0
H-14225
Cntalou size
Meler size
Tubini!. size
H-14224
Cat.aloe size
Meter size
Tubinl! size
n
Jilit~I)t{{ i1A:fri;J
H-14223
..
Catnlol! size
Meter size
Tubint• or pipe sii:e
H-14222
Cntalo1• number
Mctcr size
Tub in I!: or pipe size
Straight coupling
Multi-purpose thread x
compression coupling for
copper tubing
5/8x3/4x3/4
518, 518X314 314
3/4
Straight coupling
Multi-purpose thread x copper
flare nut
5/8xJ/4x3/4 I
5/8, 5/8x3/4, 3/4 I
314 I
Straight coupling
Multi-purpose thread x copper
flare or M.1.P. thread*
5/8xJ/4xJ/4 I 5/8xJ/4xl I
518", 518"X3/4" 314" I
314 11 I
Straight coupling _
Multi-purpose thread x copper
flare or F.1.P. *
i
5/8xJ/4x3/4 I
518. 5/8x314, 314 I
314 I
0
H-14221
Catnlo1• size
Meter size
Pioe size
H-14220
CataloJi size
Meter size
Pioe size
H-14231
Cata.IOI? size
Meter size
Tubina size
Straight coupling
Multi-purpose thread x
compression connection with
plain gasket and locking type
nut for steel pipe
5/8x3/4x3/4
518 5/8x3/4, 314
314
Straight coupling
. Multi7purpose thread x_
compression connection with
plain gasket for steel pipe
5/8x3/4x3/4
5/8, 5/BxJ/4 3/4
3/4
Straight coupling
Multi-purpose thread x
sweat-joint solder connection
5/8x3/4xJ/4 I 5/8x3/4xl I
· 518 518x3/4, 3/4 I
314 11 I
I
I '"This co~pli1:1S can_ be used to make a copper flare connection or 11 threru:ied iron pipe connection. MUELLER• Copper Meter Yoke Couplings are manufactured and tested in accordance with ANSI/AWWA CB00.
I
REVIEWED
ROY F. WESTON, INC.
, ., NO EXCEPTIONS TAKEN
EXCEPTIONS TAKEN AS NOTED
0 REVlSE AND RESUBMIT
0 REJECTED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design
concept and for compliance with standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detail and
dimension, nor for deviation from Contract
Document requirements, except as noted and
accepted in writing at the time of submittal of
Enginer-f . . I
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noEND CONNECTIONS FOR COPPER METER YOKES WITH MULTI-PURPOSE ENDS
H 14227 -
kntnlm: size
h,leter size
ITubinl! size
H-14228
Catn!ot.: size
Meier size
Pipe size
.,,_
5/8x3/4xJ/4 11
518. 5l8xJl4. 314 11
3/4 11 .
5/8x3/4xJ/4 1
5/8, 5/BxJ/4, 3/4 1
3/4 1
Straight coupling
F.I.P x male multi-purpose
thread
Used to adapt M.1.P. yokes to·
multi-purpose couplings
507310 / 507311
P:m no. 1507310 50731 I CatnlO!! size !J/4 1
Meter size 5/S, 5/SxJ/4, J/4 1 . oioe size ·Y4 1
. P-14227
Catalou size
Meter size
Tubinl! size
H-14230
Cntnlol! size
Meier size
Tubim.!. size
H-14229
Catalut.: size
Meter size
Tubin!:! size
(Mueller Co.I ~ 8A.41
REV. 4-99
Straight coupling
Multi-purpose thread x
MUELLER® Pack Joint
Connection for CTS 0.0. • tubing
. I 5/SxJ/4xJ/4 ! I
I 51s. S!Sx3l4. 314 Ii
. I 3/4 I 1
j5/8xJ/4x3/4 I 1
I sis. 5/SxJ/4, 314 I 1
IJ/4 11
Straight coupling
Multi-purpose thread x MUELLER INSTA-TITE
C_omicction for !PS* PE plastic pipe
I 5/8xJ/4xJ/4
! 5/8. 5/SxJ/4, 3/4 : I I
I
TRANS-STATE CONSTRUCTION CO.
·11vVA?PROVED
Cl /'.f·'P,:OVED AS NOTED
C:l NOT /,PF'ROVEO
AA&WJ¾MMiiii ; ifi? '"See ch:ms o~ page-~ :-\_..;_1 .:::,: ~.-\A4 fllr tuhing ;ind pipe tha1 may be used with these connections. MUELLER•·coppsr '.:em Yoke Couplings are manufactured and tested in accordance with ANSI/AWWA CBOO.
REVIEWED
ROY F. WESTON, INC.
~~O EXCEPTIONS TAKEN
□ EXCEPTIONS TAKEN AS NOTED
0 REVISE AND RESUBMIT
□ REJECTED -DOES NOT COMPLY
WITII PROJECT REQUIREMENTS
Reviewed for conformance wth project design
concept and for compliance with standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detail and
dimension, nor for deviation from Contract
Document requirements, except as noted and
accepted iri writing at the time of submittal of
Engineer. . ·
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nu,COP~ER METER YOKES WITH
HORIZONTAL INLET AND OUTLET
IMuelle, Ca.I
Typical installation of a horizontal inlet and
Copper meter yokes with horizontal inlet and outlet and multi -purpose thread ends
Catalog number
Description
H-1400 I H-1401 H-1404, v IH-1405 B-2404 Plain yoke With test valve With lock wing With lock wing With lock win&J ground key nngle me-ground key angle me-MUELLER3 nt ter stop ter stop and test valve Angle Bnll Valve•·
' Check valve options
MUELLER Copper Meter Yokes can be ordered with one of the following: an ASSE approved top entry venical check valve ( except 5/8" yoke); an ASSE approved dual check valve; a dual check valve ( ASSE non-approved). To order the ASSE approved top entry check feature, add a suffix of -6A to the yoke cataloge number; add -6D for the same check with a test drain. For the dual check feature, add a suffix of -2A to the yoke catalog number for the ASSE approved model or -2 suffix for the nonapproved model. Examples:
I B-2405
With lock wincfu MUELLER J An• gle Bail Valve• nnd test valve
M-98™ ASSE approved top entry vertical check valve
H-1404-6D for the ASSE approved top entry vertical check with a test drain; H-1404-2A for the ASSE approved model angle dual check valve. Angle dual check valve
Dimensions
Meter size 5/8" 15/8" X 3/4" ' 13/4". 11'"
Nominal size ofl.P. thrend in meter nut J/4" l" l" 1-1/4" Dimension A 1-l/t6" 1-S/16" l-5/t6" 1-5/8" Dimension B 7-7/8" 7-7/8" 9-5/16" l l-l/t6" Dimension C -nominal pipe size 3/4" 3/4" 3/4" l" of inlet and outlet
Dimension D 7-15/16" 7-15/16" 9-3/8" 11-1/8" Dimension E 12-5/8" 12-5/8" 14-1/4" 17-1/4" -
Dimension F -minimum riser height 7" 7"(9" .. ) 8" (10" .. ) 10" (12" .. )
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9", 12", 15". 18", 9" 12" 15" 18" 12" 15" 18" 'I" 12", 15". 18". 21", l 21\',.24\ 27\,, 30:', 24111 17111 30"' 33 .. '· '4" '7" ~a" 33". 1 Other riser heights available 21", 24", 27", 30",
nnrl°J-6"' ' ' -' -. .., ' . 33", nnd 36" 33", and 36" and36"
• Add "R" to the end of the yok~ catalog number to order a reduced port Angle Ball Valve; EXAMPLE: 5/8x.3/4x7 B-2404R. .. Minimwn with 6A or 60 option. · ·
Copper Meter Yokes are normally supplied less end connections. See pages BA.41 and BA.42 for end connections that can be used with these yokes. · -
Noce.: th~ .5/8\ 5/8" x 3/4", and 3/4"sizcs :ire furnished with a tic baron heights greater than 15". The 1" size is furnished with a Lie baron heights g!'cater r.han !S:'. SPECIFY METER SIZE, RISER HEIGHT AND CATALOG NUMBER.
REVIEWED
ROY F. WESTON, INC.
\ ~"'
ONO EXCEPTIONS TAKEN
□ EXCEPTIONS TAKEN AS NOTED □ REVJSE AND RESUBMIT .
□ REJECTED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design ·
concept and for compliance w_ith standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detail and
dimension, nor for deviation from Contract
Document requirements, except as noted and
accepted in writing at the time of submittal of
Engineer.
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Specifk;ation Sheet Positive Displacement Meter @ . Model C-700 Bronze. Ma 1netic Drive, Extemal Threaded Spuds
Descrip1 Ion
Operation. The C-700 Ill 11. Cll:l;i!lattng pistcn st,le, pm;itil/9 ~i. .... me111 watar r 181«. ProdUat ub"bacl 11 piston which the water l'Olalt s Ira II measllfng cham-ber, each Dil':tlln revc~ be ng ~ ID a linawn IIOIUffll!: of Willer. 'The pl8tan mwement Is 1l8llafelTed by II ma~ dli'te ID II might rea~g sealad fegilt-tcr wtilch contains ttw, appof iliato raduo:llon geartnu,
Comllfiana, ID Sfllnlbl'lk. · Ale meter fUly eomp&1111 will11he AmE:rican Water W11 -ts Aesaciallcn Sluudllfd C-700 88 IIICISt rei;ently rem ICI.
' lnstah:dion. The 111eler Dhoti d l,a installed ii a cll,an pipeline, fro11 hm eny fare en ma1e,.,1i,. 11151ar 111v llleler ~ direeilon of 1low 111 bix;:ated by 1he 811U111 cast in 1he mellar """"· 111a • •-11111)1 be Installed in ~ q-lnc:lned lhes.
Applicalion. /lie me/Bl' IS fol IJGe only with POTABI.E COI.D WAmR up tt, 120 • F (60 • C) 1111d v.wking pm=u,w ur,, ID fSO ,w .. The mMlilr 1ril rcgluler a11111r rat~ly ID 1 Oll'l' + 1.11% -1.5! Ir within the AWit/A law and normal llrlws af 1/A 111 :20 GPM. Boll! pr-,. loss irrd 11c:c:uracy ts 1n made before lltipment. No adjuslmants ""9d 1D bo r lade belore lllslallalion.
Cuns1nlc:tial1, Toe rneter111:111 lists of a &fraigllt thn,ugh-ftoW ckalligned mcm """"• du u ~ moaaUtt19 clu1m-ber, verl!cal1r grooved oscn. ing pillion, high capacllv · strainer, rem..vable bc1IDm 121 rte. fut rubber liner, bodr balls With in1egral waslH,n, a 1d a magnetically drivell
ABB \Nater ~leters, Inc.
Sizes 5/811
-5/8" x 3/4"
Specifications
, Sizes: 4111• .x 112" Bllirlino Flaw GPM 1/50 : 85%-101% Pl;anJrtf GPM 1/8 .SB.5-111!% A=ncy GPM 1J4.31 CcrllinUaUs Aaw GPM 15 MIDC!mllll F1oW GPM 20 · Head....,_ et 20 GPM poi B.S
S/8" X 3/4"
1/50
1/8
1/4-20
15
20
8.S
0l)eluli ' l'lulue psi 150 150 Operat!na femperat1.re Of. 120 120
sweep Hand RegislietS:
US G:allons 10 10 Cubia Feet 1 1 rn•-Cubio Meters t/10 1110 lmcmial Galcns 10 10
Capq..ity Of Regisll!t;
LJSGalOns=) 10 1D otila Fest miiionS) 1 1 m1-Cublo Mdr:r.> (mliom) 1/10 1/10 Imperial Gaftons (miioml) 10 10
Rcgis1er Type: Pi:nnanently se Bled nilrogen gas Iii id.
Matlarials: -Be== =:;:,(§stlnn-;)~
Synthatici Polyns BO\lom Gasket -Uner Nl!nle Body Bolts stainless Steal . Measuing Cll8fflbe1 CCl!npolllllled F llymer OMslon Plate Loaded Nylon Pis1,,r, Hi\;:t lmp,ict Pe ymar Thrust Beamg Insert Loaded N)tln. DIMlla Bar l.naded NYion Slrailer Polypropylene
Register C8n 90% Copper Al IY Rogisier i.ens Tempered Glas r Re;iste1-l'l0us'tlg and I.Id Synlllulie Pol)'n er or Bronze ·
AIII
REVIEWED
ROY F. WESTON, INC.
,0 ~O EXCEPTIONS TAKEN
.!2KEXCEPTIONS TAKEN AS NOTED
0 REVISE AND RESUBMIT
0 REJECTED -DOES NOT COMPLY
WITH PROJECT REQUIREMENTS
Reviewed for conformance wth project design
concept and for compliance with standards of
quality established in the Contract Documents.
This review shall not relieve Contractor from
responsibilities for correctness of detail and
dimension, nor for deviation from Contract
Document requirements, except as. noted and·
accepted in writing at the time of submittal of
Engine r. ,
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I Appendix Q
I · Final Inspection
Checklist
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1.
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-- - -
Final Inspection Checklist
North Belmont PCE Site
-
North Belmont, Gaston County, North Carolina
Item
Accepted
Item No. Item Description (Y/N)
I. Pre-Construction Submittals/Activities:
1 Prepare/submiUreceive approval of:
(a) Plans (FSAP, QAPP, CQAP, y
HASP/GP, WMP, PC&M Plan)
(b) Specifications y
(c) Drawings y
(d) Design documentation (stamped by y
North Carolina P.E.)
2 Approvals and Permits obtained:
(a) North Carolina Department of y
Environment and Natural Resources
NCDENR Erosion Sedimentation
Control Plan approval
(b) NCDENR Application for Approval of y·
Engineering Plans and Specifications
for Water Supply Systems
(c) NCDENR approval of the Engineering y
Plans and Specifications Application
(d) North Carolina Department of y
Transportation (NCDOT) Right of Way
Encroachment Agreement
--- ---- ---- -
Pre-Final Inspection Final Inspection
Item
Accepted
Comments (YIN) Comments
y
y
y
y
Financial Responsibility/Ownership Form completed y
by EPA on August 29, 2001. --. ----
Preliminary review completed on September 5,
2001.
Final approval obtained on September 7, 2001.
Submitted on June 18, 2001. y
Approval was obtained on July 11, 2001. However,' y
the faxed copy on file is not re:adable. Please send
COM a non-faxed copy of the following: 1) July 11,
2001 letter from Mr. Munden, P.E., Head Technical
Services Branch Public Water Supply Section 2)
July 13, 2001 letter from Jessica Miles, P.E. Chief
Public Water Supply Section 3) The NCDENR
Public Water System Authorization to Construct
certificate issued on July 11, 2001.
Weston completed the form (which was an y
agreement between NC DOT and the City of
Belmont) and obtained signatures from the City of
Belmont on or about August 14, 2001. However
COM needs a fully executed copy of the agree_ment
(including signatures from NCDOT).
0 N
-
Final Inspection Checklist (continued)
North Belmont PCE Site
Item No. Item Description
(e) City of Belmont Approval
3 Notify/obtain clearance from utility
offices affected b}' construction
activities
4 Easements/access agreements
obtained
5 Permission to conduct construction
activities on private property, if
required
6 Pre-design coordination
meeting/meeting minutes
7, 90% Design review meeting/meeting
minutes
8 Pre-construction meeting/meeting
minutes
-
II. Construction Activities:
1 Work performed under supervision of
a P.E. registered in North Carolina
2 Use erosion control as necessary or
required
3 Extend water main connections to
existing structures, drain lines, and
utilities
4 Piping and accessories
5 Disinfect potable water distribution
lines
--- --
Item
Accepted
(Y/N)
y
y
y
y
y
N
N
y
y
y
N
y
-
Pre-Final lnspectiOn Final Inspection
Item
Accepted
Comments (Y/N) Comments
Letter from David Hamilton was obtained on y
October 8, 2001.
Utilities were marked prior to excavation and y
construction.
y
y
Meeting minutes were produced by Weston, but y
COM cannot locate them in the file. Please send a
copy to COM.
Meeting was conducted, but meeting minutes were y
never produced by Weston. Please produce the
meeting minutes {include list of attendees, date of
meeting, major decision points).
Meeting was conducted, but meeting minutes were y
never produced by Weston. Please produce the
meeting minutes {include list of attendees, date of
meeting, major decision points).'
Y.
y
y
Several of the water meter boxes and valve boxes N One valve box has not been replaced or
were cracked. The installed fire hydrants need to fixed. See punch list for more information.
be painted in accordance with City of Belmont
regulations. See punch list for more information.
y·
----- -- -- -
-
0 w
---·--
Final Inspection Checklist (continued)
North Belmont PCE Site
Item No'. Item Description
6 Revise residential piping to switch
service
7 Connect residences to water main
extension
8 Conduct compaction testing
9 Perform water main pressure testing
10 Perform disinfection testing
11 Pay all fees for residential hookup
12 Install Residential Carbon Filtration
Units (RCFUs) ..
13 Perform RCFU testing to determine if
North Carolina Groundwater Quality
Standards for the contaminants of
concern are met.
14 Site restoration (soil
compaction/grading;
reseeding/strawing; paving
repair/resurfacing; general
housekeeping}
15 Dispose of all wastes in accordance
with federal, state, and local
requirements
16 Repave roads as directed by DOT
Ill. Post-Construction Submittals/Actions:
1 Verify that water meets minimum
water system standards of City of
Belmont
-
Item
Accepted
(YIN)
y
N
. y
y
y
N
y
y
N
y
N
N
- - - - -- ------
Pre-Final Inspection Final Inspection
Item
Accepted
Comments (YIN) Comments
y
Some of the residents who established City of y
Belmont accounts after January 22, 2002, need to
be connected .
y
y
y
Some of the City of Belmont account establishment N Letter has not been submitted. Please
fees ($15 each) remain to be paid. COM needs a · obtain and submit by March 27, 2002.
letter or an e-mail from the City of Belmont that all
fees (not deposits} have been paid by Trans-State
Construction.
y
. y
The main staging area needs to be graded, N Most of the items identified in the pre-final
reseeded, and landscaped. Areas around many of inspection have been completed. However,
the meter boxes and fire hydrants need additional the main staging area needs some
landscaping and reseeding. Several other additional grading and/or soil to correct low
construction areas need to be landscaped and spots.
reseeded. See punch list for more information.
y
Roads were repaved, but have several deficiencies y
as noted in the punch list.
A copy of the letter submitted to the City of Belmont N Letter should be completed by the City of
by Mr. Hamilton indicating his approval of the post-Belmont on March 25, 2002.
construction submittals and water main construction
· is required for the files.
0 ;,.
-
Final Inspection Checklist (continued)
North Belmont PCE Site
Item No. Item Description
2 Locate/survey all construction piping
and accessories including existing
utilities and update the record
drawings
3 Provide report on water main
pressure testing
4 Provide report on disinfection testing
5 Provide report on compaction testing
6 Provide report on RCFU initial testing
7 Sample and analyze water treated via
RCFUs after 6 months of operation;
provide results
6 Maintain RCFUs for 1 year following
demobilization
9 Replace all activated carbon in
RCFUs after 1 year of operation
10 Submit record drawings
11 Weekly Status Reports (including
schedule) provided to COM
12 Provide Certificate of Completion
13 Provide Gaston County Plumbing
Inspection Reports
- --
Item
Accepted
(Y/N)
N
N
N
N
y
N
N
N
N
N
N
N
-
Pre-Final Inspection Final Inspection
Item
Accepted
Comments (Y/N) Comments
Approval of record drawings will constitute y Minor corrections are required on sheet 1 of
acceptance of this item. 1 O. See punch list for more information.
y
y
y The report has been provided but data from
one retest is still required. See punch list
for more information.
y
.N This requirement will continue past the final
inspe(?tion date.
This requirement will continue past the final N This requirement will continue past the final
inspection date. inspection date.
. This requirement will continue past the final N This requirement will continue past the final
inspection date. inspection date.
y
Weekly status reports have been submitted, but an N Updated schedule still has not been
updated schedule which reflects actual dates for submitted and is past due.
project activities has not been produced. The
current project schedule should be updated to
reflect the actual dates that items were completed.
The schedule should show when approvals/permits
were obtained. The schedule should also show that
all residents (who established city accounts) were
connected by January 22, 2002, aS required by the
contract. The correct dates for each of the project
meetings should be indicated on the schedule. The
dates and items established at the post--
construction meeting with the City of Belmont
should be listed.
y
N These have not been submitted and are
past due. -
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-
0
in
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Final Inspection Checklist (continued)
North Belmont PCE Site
Item No. Item Description
14 Provide copies of all probated
easements
15 Provide project shop drawings
16 Provide asphalt mix confirmation/trip
tickets
17 Provide a copy of the Completion
Letter to NCDENR
18 Provide a copy of the Completion
Letter to NCDOT
-
Item
Accepted
(YIN)
N
N
N
N
N
------------
Pre.final Inspection Final Inspection
Item
Accepted
Comments (YIN) Comments
-y
y
y
The City of Belmont will sign it and send to the N The City of Belmont will sign it and send to
state. A copy (signed by the City of Belmont) the state. A copy (signed by the City of
should be provided to COM. Belmont) should be provided to COM.
Provide a copy to COM. y
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· AppendixR
Completion Notification
Letter to City of Belmont
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February 21, 2002
Barry L. Webb
City Manager
City of Belmont
115 N. Main Street
P.O. Box431
Roy F. Weston, Inc.
Suite 200
5405 Metric Place
Norcross, Georgia 30092-2550 .
® 770-263-5400 • Fax [phone]
www.rfweston.com
Belmont, North Carolina 28012
Re: Certification of Completion
Water System Improvements
North Belmont PCE Site
Dear Mr. Webb:
Roy F. Weston, Inc. is providing you with this letter of certification that the
Improvements to the Water System in North Belmont are complete and were installed in
accordance with the approved plans and specifications, to the best of my knowledge and
belief. This certification is based on periodic observations of the construction,
documented test results, and final inspections made personally by me and representatives
of Camp, Dresser and McKee, Inc. (Project Managers for the funding agency--USEPA).
If you should have any questions, don't hesitate to contact me at [phone].
Sincerely,
Roy F. Weston, Inc.
1. flMJ.A l~Ll
F. D:u~~f ~oney, P.E.
Design Services Manager
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Appendix S
Completion Notification
Letter to U.S. Department
of Transportation
I TRA~lS-STRTE CONSTR. co ID:704-827-4739 FEB 11 '02 9:10 No.001 P.02
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TRANS-STATE-CONSTRU.CTION COMPANY
, lJTIUJY CONTRACTOR .
January 20, 2002
Department ofTransportation
P.O. Box47
Shelby, NC 281S1
Attn: M.L, Holder>P.E.
Re: City of Belmont -ltlght of Way Encroachment Dated Sept. 17, 2001
Dear Mr. Holder:
MEMBER: AGCAND NUCA
Trans-State is notifying you that the water lino installation for the above lli!ted encroachment has
been completed,
If you have any questions, &el tree to contact me at [phone].
. '
TAR/at
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P.O. BOX 545 •DENVER.NC 28097 • TEL 704 827•2468 • FAX [phone]
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· Appendix T
Recommendation for Ownership
and Operation of Water Main
MAR 25 '02 12:02 FR FPS INC 336 855 5648 TO 18654813835
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FINKBEINER, PETTIS & STROUT, INC.
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i'A ):,,;':'itll :f1N1i 1-.NC,INU\ll:-1
r,:,·1·11-nl.l$Hi:.1i 11,lO(l
ON1, WOOl)l~..,_WN Gk.U~N
200 t:/'Sr W\)<lfll.AWN lU)Al)
s1..1rn; 124
~:1 IAlll.l)'n'ic, NC 2~117
704•!'2!;:11 I?
7u,4,;2~-7M2ll \:AX
RS
March 25, 2002
Mr. Barry Webb
City Manager
City of Belmont
P.O. Box431
Charlotte, NC 28012
Dear Barry:
Re: Belman~ NC
North Belmont PCE Site
Water System improvements
FPS is in receipt of Record Documents for the subject project from Mr. Douglas Mooney of Roy F. Weston, Inc. The documents include the following:
• Sealed and signed reproducible Record Drawings (dated 3/22/02) and digital drawing files on CDROM .
• Sealed and signed Record Document Technical Specifications (dated 2120/02)
• Copies of signed and Recorded Easements
• Record Document notebook containing eight sections (dated 2/21/02):
1. City water connection location table
2. Certification of Completion of Work signed by Mr. Mooney
3. Notification of Completion of Work to NCDOT signed by Mr. Trot Reeves
of Trans-State Construction Company
4. Approved Shop Drawings
5. Pressure Test Certification
6. Disinfection Procedure Results
7. Compaction Test Results
8. Asphalt Mix Fonnula.
After reviewing these items we find them acceptable documentation for the Project record. We hereby see no reason for the City not to accept these water system improvements for ownership and operation by the City of Belmont.
Barry, we also understand that David Isenhour is in receipt of identical documentation. Please have David notify Mr. Mooney if he needs further copies or additional information for his files. Please contact me if you have any questions.
C: David Isenhour, Belmont Public Utilities Director (by fax)
Douglas Mooney, Roy F. Weston, Inc. (by fax)
Jim LaForest, COM (by fax)
ltr • bel pea rec doc acceptance to city 002502
** TOTAL PAGE.02 **
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EPA Region 4 Remedial Project Manager/Giezelle Bennett
USEP A Region 4 ..
61 Forsyth Street, S.W.
Atlanta, Georgia 30303-8960
COM Federal Project Manager/James Laforest
800 Oak Ridge Turnpike, Suite B-200
Oak Ridge, Tennessee 37830
COM Federal Document Control File
1526 Cole Boulevard, Building 3, Suite 150
Golden, Colorado 80401
3 copies
1 copy
1 copy